A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score

Ferrando, Carlos; Suárez-Sipmann, Fernando; Librero, Julián; Pozo, Natividad; Soro, Marina; Unzueta, Carmen; Brunelli, Andrea; Peiró, Salvador; Llombart, Alicia; Balust, Jaume; Aldecoa, César; Díaz‐Cambronero, Óscar; Franco, Tania; Redondo, Francisco Javier Toledano; Garutti, Ignacio; Garcı́a, José I.; Ibáñez, Maite; Granell, Manuel; Rodríguez, Aurelio; Gallego, L.; Matta, Manuel de la; Marcos, Jose Miguel; García, Jimena Laiseca; Mazzinari, Guido; Tusman, Gerardo; Villar, Jesús

doi:10.23736/s0375-9393.19.13932-6

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…The PHYSIO+++ trial will potentially unmask hidden hypoxaemia by screening patients with the Air Test 90. The validity of a postoperative Air Test to diagnose atelectasis and predict PPC has been demonstrated 21 22. However, the Air Test has not previously been used by physiotherapists to enrich a study population.…”

Section: Discussionmentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

“…Intentional removal of prescribed oxygen therapy during measurement of peripheral oxyhaemoglobin saturations (SpO 2 ) has previously been used as a proxy measure for atelectasis in postoperative populations 21 and can predict poor outcomes. 22 Hypoxaemia, in this study, will be diagnosed at the bedside with the Air Test 90. To conduct The Air Test 90, the screening clinician will remove the conventional or high flow oxygen therapy device (HFOT) for a maximum of 2 min while continuously monitoring SpO 2 using a finger probe attachment.…”

Section: Assessment For Hypoxaemiamentioning

confidence: 99%

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PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

Hackett,

Denehy,

Kruger

et al. 2023

BMJ Open

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IntroductionFew clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial of physiotherapist-led non-invasive ventilation (NIV).Methods and analysisThis single-centre, 50-patient, parallel-group, assessor blinded, pilot feasibility randomised controlled trial with concealed allocation will enrol spontaneously ventilating adults with hypoxaemia within 72 hours of major abdominal surgery. Participants will receive either (1) usual care physiotherapy of a single education session (talk), daily walking of 10–15 min (walk) and four sessions of coached deep breathing and coughing (breathe) or (2) usual care physiotherapy plus four 30 min sessions of physiotherapist-led NIV delivered over 2 postoperative days. Primary feasibility and safety outcome measures are; number of eligible patients recruited per week, total time of NIV treatment delivered, acceptability of treatments to patients and clinicians and incidence of adverse events. Secondary feasibility outcomes include measures of recruitment and treatment adherence. Exploratory outcome measures include change in respiratory parameters, postoperative pulmonary complications, length of hospital stay, health-related quality of life, postoperative activity levels and mortality.Ethics and disseminationEthics approval has been obtained from the relevant institution. Results will be published to inform future research.Trial registration numberACTRN12622000839707.

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Section: Discussionmentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Section: Assessment For Hypoxaemiamentioning

confidence: 99%

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PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

Hackett,

Denehy,

Kruger

et al. 2023

BMJ Open

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“…When using the nomogram, only one variable should be positioned on the corresponding axis, and the points of all variables are summed to determine risk. Some scholars have carried out nomogram research in the field of anesthesia and achieved good results ( Ferrando et al., 2020 ; Ge et al, 2018 ; Hahn, 1995 ; Zhou et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery

Wang

Chen

Zhao

et al. 2021

PeerJ

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Background Postoperative pulmonary complications (PPCs) after thoracoscopic surgery are common. This retrospective study aimed to develop a nomogram to predict PPCs in thoracoscopic surgery. Methods A total of 905 patients who underwent thoracoscopy were randomly enrolled and divided into a training cohort and a validation cohort at 80%:20%. The training cohort was used to develop a nomogram model, and the validation cohort was used to validate the model. Univariate and multivariable logistic regression were applied to screen risk factors for PPCs, and the nomogram was incorporated in the training cohort. The discriminative ability and calibration of the nomogram for predicting PPCs were assessed using C-indices and calibration plots. Results Among the patients, 207 (22.87%) presented PPCs, including 166 cases in the training cohort and 41 cases in the validation cohort. Using backward stepwise selection of clinically important variables with the Akaike information criterion (AIC) in the training cohort, the following seven variables were incorporated for predicting PPCs: American Society of Anesthesiologists (ASA) grade III/IV, operation time longer than 180 min, one-lung ventilation time longer than 60 min, and history of stroke, heart disease, chronic obstructive pulmonary disease (COPD) and smoking. With incorporation of these factors, the nomogram achieved good C-indices of 0.894 (95% confidence interval (CI) [0.866–0.921]) and 0.868 (95% CI [0.811–0.925]) in the training and validation cohorts, respectively, with well-fitted calibration curves. Conclusion The nomogram offers good predictive performance for PPCs after thoracoscopic surgery. This model may help distinguish the risk of PPCs and make reasonable treatment choices.

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“…Atelectasis acts as a lung stress-raiser promoting ventilatorinduced lung injury, and is thus considered a risk factor for developing PPCs. 20 For instance, lung collapse reduces respiratory system compliance, which results in an increase in driving pressure, [21][22][23] an independent predictor for PPCs. 24 In our study, the open lung condition was associated with lower driving and plateau pressures.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative open lung condition and postoperative pulmonary complications. A secondary analysis of iPROVE and iPROVE‐O2 trials

Ferrando

Librero

Tusman

et al. 2021

Acta Anaesthesiol Scand

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Background:The preventive role of an intraoperative recruitment maneuver plus open lung approach (RM + OLA) ventilation on postoperative pulmonary complications (PPC) remains unclear. We aimed at investigating whether an intraoperative open lung condition reduces the risk of developing a composite of PPCs.Methods: Post hoc analysis of two randomized controlled trials including patients undergoing abdominal surgery. Patients were classified according to the intraoperative lung condition as "open" (OL) or "non-open" (NOL) if PaO 2 /FIO 2 ratio was ≥ or <400 mmHg, respectively. We used a multivariable logistic regression model that included potential confounders selected with directed acyclic graphs (DAG) using Dagitty software built with variables that were considered clinically relevant based on biological mechanism or evidence from previously published data. PPCs included severe acute respiratory failure, acute respiratory distress syndrome, and pneumonia.Results: A total of 1480 patients were included in the final analysis, with 718 (49%) classified as OL. The rate of severe PPCs during the first seven postoperative days was 6.0% (7.9% in the NOL and 4.4% in the OL group, p = .007). OL was independently | 31 FERRANDO Et Al.

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A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score

Cited by 12 publications

References 29 publications

PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery

Intraoperative open lung condition and postoperative pulmonary complications. A secondary analysis of iPROVE and iPROVE‐O2 trials

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