Brueckmann et al developed a score for predicting the risk of postoperative reintubation in a surgical patient. This can help to identify a patient who may benefit from more aggressive or an alternative management. The authors are from Massachusetts General Hospital, Brigham and Women's Hospital, and Essen-Druisburg University.
Patient selection: adult surgical
Outcome: reintubation (as indication of severe postoperative respiratory complications)
Parameters:
(1) ASA classification
(2) timing for procedure (emergency, urgent, etc, with emergency defined as procedure with the patient in the operating room within 30 minutes of the case being booked as an emergent case)
(3) risk level of surgical service for reintubation
(4) congestive heart failure (CHF)
(5) chronic pulmonary disease
|
Parameter |
Finding |
Points |
|
ASA classification |
1 or 2 |
0 |
|
|
3, 4 or 5 |
3 |
|
timing |
nonemergency |
0 |
|
|
emergency |
3 |
|
risk level |
not high risk |
0 |
|
|
high risk |
2 |
|
CHF |
absent |
0 |
|
|
present |
2 |
|
chronic pulmonary disease |
absent |
0 |
|
|
present |
1 |
where:
• High risk surgical services: vascular, transplant, neuro, thoracic, general, burn.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the more likely that the person would be reintubated.
|
Score |
Reintubation Rate |
|
0 |
0.1% |
|
1 to 3 |
0.4% |
|
4 to 6 |
1.6% |
|
7 to 11 |
6% |
Performance:
• Area under the ROC curve: 0.81.
Specialty: Pulmonology, Surgery, general
ICD-10: ,
