Rujirojindakul et al identified risk factors for reintubation of a patient in the post-anesthetic care unit. These can help to identify a patient who may benefit from more aggressive management before and after extubation. The authors are from Prince of Songkla University in Thailand.
Patient selection: post-anesthesia care unit, ASA I to IV
Parameters:
(1) age in years
(2) COPD
(3) hypoalbuminemia (serum albumin < 4 g/dL)
(4) estimated creatinine clearance
(5) emergency surgery
(6) ASA status
(7) type of surgery
(8) duration of surgery in hours
(9) neuromuscular blocking agent used
|
Parameter |
Findings |
OR |
|
age in years |
< 1 year of age |
16.4 |
|
|
1 to 10 year of age |
2 |
|
|
11 to 29 year of age |
1.8 |
|
|
30 to 49 year of age |
1 |
|
|
50 to 65 year of age |
0.9 |
|
|
> 65 year of age |
1 |
|
COPD |
no |
1 |
|
|
yes |
2.1 |
|
serum albumin |
>= 4.0 g/dL |
1 |
|
|
< 4.0 g/dL |
4.9 |
|
creatinine clearance |
> 60 mL/min |
1 |
|
|
25 to 60 mL/min |
2.5 |
|
|
< 25 mL/min |
4.1 |
|
emergency surgery |
no |
1 |
|
|
yes |
1.8 |
|
ASA status |
I |
1 |
|
|
II |
1.6 |
|
|
III |
3.8 |
|
|
IV |
11.4 |
|
type of surgery |
head and neck |
3.4 |
|
|
airway |
32.2 |
|
|
cardiac |
3.8 |
|
|
thoracic |
6.3 |
|
|
other |
1 |
|
duration of surgery |
< 1 hour |
1 |
|
|
1 to 3 hours |
1.3 |
|
|
> 3 hours |
3 |
|
neuromuscular blocking agent |
none |
1 |
|
|
succinyl choline |
3.7 |
|
|
aminosteroid derivative |
7.3 |
|
|
benzylisoquinoline |
3.9 |
cumulative odds ratio for reintubation =
= PRODUCT(odd ratios for the 9 parameters)
Interpretation:
• minimum cumulative odds ratio: 1
• maximum cumulative odds ratio: > 5,000
Specialty: Pulmonology, Surgery, general
ICD-10: ,
