From the Guidelines
Postoperative atelectasis can be predicted using various risk assessment tools, including the ARISCAT score, which evaluates seven independent risk factors, and the Gupta Perioperative Risk for Respiratory Complications calculator, which incorporates type of surgery, functional status, and comorbidities. Several predictive tools can help identify patients at risk for postoperative atelectasis, including the Canet Risk Score, Arozullah Respiratory Failure Index, ARISCAT score, Melbourne Risk Prediction Tool, and Gupta Perioperative Risk for Respiratory Complications calculator 1. These tools evaluate various factors such as age, preoperative SpO2, respiratory infection, anemia, surgical site, duration of surgery, and emergency procedure to predict respiratory complications.
Key Factors to Consider
- Age: Advanced age is an important predictor of postoperative pulmonary complications, even after adjustment for comorbid conditions 1.
- Chronic lung disease: Patients with chronic obstructive pulmonary disease (COPD) or asthma are at higher risk for postoperative pulmonary complications 1.
- Surgical site: Patients undergoing prolonged surgery, abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and general anesthesia are at higher risk for postoperative pulmonary complications 1.
- Functional status: Patients with functional dependence are at higher risk for postoperative pulmonary complications 1.
Recommendations
- Use a dedicated score, such as the ARISCAT score, to evaluate preoperative pulmonary risk 1.
- Implement preventive strategies such as incentive spirometry, early mobilization, optimal pain management, and respiratory therapy for high-risk patients 1.
- Use individualized mechanical ventilation to improve the mechanics of breathing and respiratory function, and prevent postoperative pulmonary complications 1.
- Consider using positive airway pressure treatment to prevent hypoxic events in the postoperative phase, especially in patients with obstructive sleep apnea (OSA) 1.
From the Research
Postoperative Atelectasis Predictive Tools for Risk
- Postoperative atelectasis is a common problem following any surgery, and its risk can be increased by various factors such as pain, thoracic muscle injury, chest wall instability, and diaphragmatic dysfunction 2.
- Studies have identified several risk factors for postoperative atelectasis, including age ≥ 70 years, smoking history, decreased preoperative forced expiratory volume in one second (FEV1), and lobectomy 3.
- A nomogram model has been developed to predict the risk of postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery, which can help clinicians identify high-risk patients and provide targeted interventions 3.
- Perioperative interventions, such as the use of continuous positive end-expiratory pressure (PEEP) during mechanical ventilation, can significantly reduce the incidence of atelectasis 4.
- Other interventions, such as non-invasive pressure support ventilation, physical therapy, and changing the dose of general anesthesia, may also be effective in preventing postoperative atelectasis 4.
Predictive Models and Tools
- A nomogram model has been developed to predict the risk of postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery, which includes factors such as age, smoking history, preoperative FEV1, and type of surgery 3.
- The model has been validated and shown to have good discrimination and calibration, with an area under the receiver operating characteristic curve of 0.826 and 0.918 in the training and validation sets, respectively 3.
- The use of predictive models and tools, such as the nomogram model, can help clinicians identify high-risk patients and provide targeted interventions to prevent postoperative atelectasis.
Clinical Applications
- Clinicians can use the nomogram model to predict the risk of postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery, and provide targeted interventions such as PEEP, non-invasive pressure support ventilation, and physical therapy 3, 4.
- The use of predictive models and tools can help reduce the incidence of postoperative atelectasis and improve patient outcomes, particularly in high-risk patients 3, 4.