TY - JOUR
T1 - Predicting postoperative pulmonary complications in high-risk populations
AU - Weingarten, Toby N.
AU - Kor, Daryl J.
AU - Gali, Bhargavi
AU - Sprung, Juraj
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/4
Y1 - 2013/4
N2 - Purpose of Review: Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). Recent Findings: Because of the increased rate of severe perioperative respiratory complications in patients with OSA, the American Society of Anesthesiologists issued practice guidelines for perioperative management. When OSA is diagnosed preoperatively, the rate of postoperative pulmonary complications is low and not associated with OSA severity. However, OSA continues to be an important risk because a substantial proportion of patients in the contemporary surgical population have undiagnosed OSA. Strategies based on preoperative and immediate postoperative clinical signs and symptoms can help identify patients with a high likelihood of OSA, postoperative desaturations, and pulmonary complications. ARDS is another serious postoperative complication associated with high mortality rate and limited treatment options, and its prevention is critical. Practice changes have led to a dramatic reduction in ARDS incidence. A recently developed prediction model can help identify high-risk patients. Summary: Evidence is emerging that early identification of modifiable risk factors and implementation of 'protective' management strategies may lead to reduction of severe postoperative pulmonary complications.
AB - Purpose of Review: Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). Recent Findings: Because of the increased rate of severe perioperative respiratory complications in patients with OSA, the American Society of Anesthesiologists issued practice guidelines for perioperative management. When OSA is diagnosed preoperatively, the rate of postoperative pulmonary complications is low and not associated with OSA severity. However, OSA continues to be an important risk because a substantial proportion of patients in the contemporary surgical population have undiagnosed OSA. Strategies based on preoperative and immediate postoperative clinical signs and symptoms can help identify patients with a high likelihood of OSA, postoperative desaturations, and pulmonary complications. ARDS is another serious postoperative complication associated with high mortality rate and limited treatment options, and its prevention is critical. Practice changes have led to a dramatic reduction in ARDS incidence. A recently developed prediction model can help identify high-risk patients. Summary: Evidence is emerging that early identification of modifiable risk factors and implementation of 'protective' management strategies may lead to reduction of severe postoperative pulmonary complications.
KW - acute respiratory distress syndrome
KW - hypercapnic respiratory failure
KW - hypoxic respiratory failure
KW - obstructive sleep apnea
KW - prediction scores
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U2 - 10.1097/ACO.0b013e32835e21d2
DO - 10.1097/ACO.0b013e32835e21d2
M3 - Review article
C2 - 23407151
AN - SCOPUS:84874949053
SN - 0952-7907
VL - 26
SP - 116
EP - 125
JO - Current Opinion in Anaesthesiology
JF - Current Opinion in Anaesthesiology
IS - 2
ER -