Identification of Patients at Risk for Postoperative Respiratory Complications Using a Preoperative Obstructive Sleep Apnea Screening Tool and Postanesthesia Care Assessment
Identification of Patients at Risk for Postoperative Respiratory Complications Using a Preoperative Obstructive Sleep Apnea Screening Tool and Postanesthesia Care Assessment
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DOI：
10.1097/aln.0b013e31819b5d70
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发表时间：
2009-04-01
期刊：
影响因子：
8.8
通讯作者：
Plevak, David J.
中科院分区：
文献类型：
--
作者：
Gali, Bhargavi;Whalen, Francis X.;Plevak, David J.
背景：阻塞性睡眠呼吸暂停患者有围手术期发病的风险。作者使用阻塞性睡眠呼吸暂停筛查预测模型来生成睡眠呼吸暂停临床评分 (SACS)，该评分可识别阻塞性睡眠呼吸暂停高风险或低风险的患者。这与麻醉后监护室 (PACU) 监测相结合，旨在识别术后氧饱和度降低和呼吸系统并发症高风险的患者。 方法：在这项前瞻性队列研究中，纳入了住院时间超过 48 小时且同意的手术患者。计算 SACS（高风险或低风险）；所有患者均在 PACU 中接受监测，观察呼吸缓慢、呼吸暂停、饱和度降低、抗痛镇静不匹配等反复发作情况。所有患者术后均进行脉搏血氧饱和度测定；记录了并发症。使用卡方、双样本t检验和逻辑回归进行分析。计算氧去饱和指数（每小时去饱和次数）。氧饱和度指数和术后心肺并发症的发生率是主要终点。结果：共纳入 693 名患者。根据多变量逻辑回归分析，术后氧饱和度指数大于 10 的可能性随着高 SACS（比值比 = 1.9，P < 0.001）和复发 PACU 事件（比值比 = 1.5，P = 0.036）而增加。术后呼吸事件也与高 SACS（比值比 = 3.5，P < 0.001）和复发性 PACU 事件（比值比 = 21.0，P < 0.001）相关。结论：术前阻塞性睡眠呼吸暂停筛查工具 (SACS) 和复发性 PACU 呼吸事件的结合与较高的氧饱和度指数和术后呼吸并发症相关。识别围手术期呼吸饱和度降低和并发症风险较高的患者的两阶段过程可能有助于术后对手术患者进行分层和管理。
Background: Patients with obstructive sleep apnea are at risk for perioperative morbidity. The authors used a screening prediction model for obstructive sleep apnea to generate a sleep apnea clinical score (SACS) that identified patients at high or low risk for obstructive sleep apnea. This was combined with postanesthesia care unit (PACU) monitoring with the aim of identifying patients at high risk of postoperative oxygen desaturation and respiratory complications.Methods: In this prospective cohort study, surgical patients with a hospital stay longer than 48 h who consented were enrolled. The SACS (high or low risk) was calculated; all patients were monitored in the PACU for recurrent episodes of bradypnea, apnea, desaturations, anti pain-sedation mismatch. All patients underwent pulse oximetry postoperatively; complications were documented. Chi-square, two-sample t test, and logistic regression were used for analysis. The oxygen desaturation index (number of desaturations per hour) was calculated. Oxygen desaturation index and incidence of postoperative cardiorespiratory complications were primary endpoints.Results: Six hundred ninety-three patients were enrolled. From multivariable logistic regression analysis, the likelihood of a postoperative oxygen desaturation Index greater than 10 was increased with a high SACS (odds ratio = 1.9, P < 0.001) and recurrent PACU events (odds ratio = 1.5, P = 0.036). Postoperative respiratory events were also associated with a high SACS (odds ratio = 3.5, P < 0.001) and recurrent PACU events (odds ratio = 21.0, P < 0.001).Conclusions: Combination of an obstructive sleep apnea screening tool preoperatively (SACS) and recurrent PACU respiratory events was associated with a higher oxygen desaturation Index and postoperative respiratory complications. A two-phase process to Identify patients at higher risk for perioperative respiratory desaturations and complications may be useful to stratify and manage surgical patients postoperatively.