A Scoring System to Predict Unplanned Intubation in Patients Having Undergone Major Surgical Procedures

Abstract

Background-Unplanned tracheal intubation after surgery has been associated with high mortality. Few studies have examined the risk factors for this complication.

Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort

“…[8][9][10] The incidence of PRF in general surgical populations ranges between 0.2 and 3.4% 8 and several scoring systems for predicting PRF have been proposed. 1,[3][4][5][6][7]11 However, previous studies developing scores to predict PRF have defined this complication in different ways. Definitions that have been used include unexpected tracheal reintubation, 1,5,7,11 the need for postoperative mechanical ventilation 1,3 or postoperative acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).…”

“…1,[3][4][5][6][7]11 However, previous studies developing scores to predict PRF have defined this complication in different ways. Definitions that have been used include unexpected tracheal reintubation, 1,5,7,11 the need for postoperative mechanical ventilation 1,3 or postoperative acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). 4,6 In addition, the majority of the available scoring systems have been developed from retrospective databases that contain administrative information and coding.…”

“…4,6 In addition, the majority of the available scoring systems have been developed from retrospective databases that contain administrative information and coding. 1,3,[5][6][7]11 Retrospectively identified predictors have certain limitations, [12][13][14][15] including low positive predictive values and moderate reliability, and they are subject to errors in data collection, higher percentages of missing values and the lack of information on variables of clinical interest.…”

Epidemiology of the high-risk population

“…There are several risk scores to identify patients at risk for postoperative pulmonary complications (PPC) [27][28][29]. The ARISCAT score, which defines a low, intermediate and a high-risk group for PPC, has recently been validated in the PERISCOPE study [30].…”

Risk factors for post-operative respiratory failure among 94,621 neurosurgical patients from 2006 to 2013: a NSQIP analysis

“…In one study, independent predictors of unplanned intubation in general surgery patients included age of the patient, American Society of Anesthesiologists (ASA) classification, pre-operative sepsis, and total operative time [8].…”