From the Guidelines
The Gupta Perioperative Risk for Respiratory Complications calculator does not specifically predict atelectasis risk, and therefore, other preventive measures such as incentive spirometry, early mobilization, adequate pain control, and deep breathing exercises should be considered to prevent atelectasis and other pulmonary complications. The calculator primarily focuses on predicting the risk of postoperative respiratory failure requiring mechanical ventilation and pneumonia within 30 days after surgery. Atelectasis, while a common postoperative respiratory complication, is not directly quantified by the Gupta score. The calculator uses factors such as age, ASA class, preoperative functional status, emergency status, procedure type, and preoperative sepsis to generate its risk prediction.
Key Points to Consider
- Atelectasis occurs when alveoli collapse or fill with fluid, often due to shallow breathing, immobility, or pain following surgery 1.
- The use of noninvasive positive pressure ventilation (NIPPV) or continuous positive airway pressure (CPAP) may be beneficial in preventing postoperative pulmonary complications, including atelectasis, in high-risk patients 1.
- Goal-directed hemodynamic therapy and epidural analgesia also have moderate evidence of benefit in the prevention of postoperative pulmonary complications, including atelectasis 1.
- Respiratory physiotherapy, including pre- and postoperative physiotherapy, may be helpful in preventing postoperative pulmonary complications, including atelectasis 1.
Recommendations
- Clinicians should implement comprehensive respiratory care protocols for all surgical patients, regardless of their Gupta score, to prevent atelectasis and other pulmonary complications.
- Patients at high risk for postoperative pulmonary complications, including atelectasis, should receive preventive measures such as NIPPV or CPAP, goal-directed hemodynamic therapy, epidural analgesia, and respiratory physiotherapy.
- Further research is needed to determine the best strategies for preventing atelectasis and other pulmonary complications in surgical patients.
From the Research
Gupta Perioperative Risk for Respiratory Complications Prediction Value for Atelectasis
- The Gupta perioperative risk index is a predictive model used to identify patients at risk for postoperative pulmonary complications (PPCs) 2.
- However, studies have shown that the Gupta index performs poorly in certain populations, such as head and neck surgery patients, with areas under the curve of 0.65 2.
- Atelectasis is a type of PPC that can occur after surgery, and the Gupta index may not accurately predict its occurrence.
- Other studies have developed predictive models for PPCs, including the ARISCAT index, which also performed poorly in head and neck surgery patients 2.
- The development of a risk calculator for postoperative respiratory failure, which includes factors such as type of surgery, emergency case, dependent functional status, preoperative sepsis, and higher American Society of Anesthesiologists (ASA) class, may be more accurate in predicting PPCs, including atelectasis 3.
Prediction of Atelectasis
- Atelectasis can be predicted using various models, including the Clinical Prediction Rule for Pulmonary Complications (CPRPC) 4.
- However, the CPRPC performed poorly in a study of lung resection patients, with an area under the receiver operating characteristic curve of 0.47 4.
- Other factors, such as age, smoking status, and predicted postoperative forced expiratory volume in 1 s, may be more accurate predictors of atelectasis 4.
- The use of continuous positive airway pressure (CPAP) therapy via mask has been shown to be effective in preventing or treating postoperative atelectasis, particularly in cardiac surgery patients 5.
- Incentive spirometry and face-mask positive end-expiratory pressure (PEEP) may also be used to prevent or treat atelectasis, but their effectiveness may vary depending on the patient population and surgical procedure 6, 5.