Preoperative risk stratification of critically ill patients.

Curtis C Copeland, Andrew Young, Tristan Grogan, Eilon Gabel, Anahat K. Dhillon, Vadim Gudzenko
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引用次数: 88

Abstract

STUDY OBJECTIVE Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure. DESIGN Retrospective cohort analysis over a 21-month period. SETTING Five adult intensive care units (ICUs) at a single tertiary medical center. PATIENTS Three hundred fifty ICU patients in respiratory failure, who underwent 501 procedures with general anesthesia. MEASUREMENTS Demographic, clinical, and surgical variables were collected from the pre-anesthesia evaluation forms and preoperative ICU charts. The primary outcome was survival to discharge. MAIN RESULTS Ninety-six patients (27%) did not survive to discharge. There were significant differences between survivors and non-survivors for ASA (3.7 vs. 3.9, p=0.001), RCRI (1.6 vs. 2.0, p=0.003), and SOFA score (8.1 vs. 11.2, p<0.001). Based on the area under the receiver operating characteristic curve for these relationships, there was only modest discrimination between the groups, ranging from the most useful SOFA (0.68) to less useful RCRI (0.60) and ASA (0.59). CONCLUSIONS This single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.
危重病人术前风险分层。
研究目的风险评估历来强调择期、门诊和非心脏手术的心脏发病率和死亡率。然而,危重患者越来越多地出现治疗干预。本研究探讨了美国麻醉医师学会(ASA)分级、修订心脏危险指数(RCRI)和顺序器官衰竭评估(SOFA)评分与危重呼吸衰竭患者生存至出院的关系。设计:21个月的回顾性队列分析。在一个三级医疗中心设有5个成人重症监护病房(icu)。患者:350例ICU呼吸衰竭患者,在全身麻醉下进行了501次手术。从麻醉前评估表和术前ICU图表中收集人口学、临床和手术变量。主要终点是存活至出院。主要结果96例(27%)患者未存活至出院。幸存者和非幸存者在ASA (3.7 vs. 3.9, p=0.001)、RCRI (1.6 vs. 2.0, p=0.003)和SOFA评分(8.1 vs. 11.2, p<0.001)方面存在显著差异。根据这些关系的受试者工作特征曲线下的面积,两组之间只有适度的区别,从最有用的SOFA(0.68)到不太有用的RCRI(0.60)和ASA(0.59)。结论:这项单中心回顾性研究量化了晚期气道危重患者围手术期的高风险:四分之一的患者无法存活出院。术前ASA评分、RCRI和SOFA评分仅部分描绘了幸存者和非幸存者。考虑到现有的局限性,未来的研究可能会确定评估工具,更相关的是在围手术期环境中区分危重患者的生存结果。
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