Predictors of an Appropriate Admission to an ICU after a Major Pulmonary Resection

Abstract

Background: There are no recommendations about admission to an ICU after a major lung resection and there are considerable differences among institutions in this respect. Objectives: To audit the practice of admission to an ICU after a major lung resection and evaluate factors predicting the need for intensive care. Methods: Clinicalrecords of all patients who underwent major pulmonary resections in a 14-month period were reviewed retrospectively. The criteria for postoperative admission to the ICU were: (1) standard pneumonectomy if comorbidity index (CI) >0 and/or ASA score >1, and/or abnormal spirometry or arterial gas analysis; (2) extended pneumonectomy; (3) lobectomy if CI ≧4 and/or ASA ≧3; (4) lobectomy if FEV₁ <60% of predicted; (5) lobectomy if FEV₁ is between 60 and 80% and hypercapnia. Results: Among the 49 patients postoperatively admitted to the surgical ward, only 1 needed late intensive care. Among the 55 patients admitted to the ICU, 25 did not require specific intensive care and were discharged 24 h postoperatively, whereas the remaining 30 patients required specific intensive care. Multivariate analysis identified ASA score, predictive postoperative DL_CO, and predictive postoperative product (PPP) as independent predictors of a need for admission to an ICU. Conclusion: This empirical protocol was useful in identifying patients not likely to need admission to the ICU. ASA score, predictive postoperative DL_CO, and PPP are independent predictors of a need for admission to an ICU.

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

“…In the late 1980s, DL,CO was first shown to be an independent predictor of post-operative mortality and morbidity after lung resection. Subsequently, similar findings have also been reported by others [37,38,[76][77][78][79][80]. A low pre-operative DL,CO was related to an increased frequency of readmission to the hospital and a poorer long-term quality of life (QoL) [81].…”

Cerebral Autoregulation is Influenced by Carbon Dioxide Levels in Patients with Septic Shock

“…Our study showed that, during septic shock, normal or high levels of PaCO 2 were associated with loss of cerebral autoregulation in all patients, whereas only 50% of patients with low PaCO 2 levels had impaired cerebral autoregulation. In septic ICU patients, hypercapnia is a common clinical event in the presence of chronic obstructive pulmonary disease, status asthmaticus, obesity hypoventilation syndrome, major pulmonary resection, neurological impairment of respiratory muscles, such as in amyotrophic lateral sclerosis, and in severe ALI/ARDS [61][62][63]. Nevertheless, no data are available about the brain autoregulatory capacity in these patients and an increased frequency of encephalopathy or ischemic brain lesions has never been associated with higher PaCO 2 levels.…”

Predicted Postoperative Product and Diffusion Heterogeneity Index in the Evaluation of Candidates for Lung Resection

“…Recently, a study also showed that predicted postoperative product, predicted postoperative D LCO , and American Society of Anesthesiology (ASA) score are independent predictors of a need for postoperative ICU admission. 22 * This is a logistic regression model that calculates the log odds of disease, which can be used to calculate the probability of outcome. † Index of diffusion heterogeneity at 70% of maximal workload.…”