Predictors Of Respiratory Complications Research Articles

Early metabolic markers as predictors of respiratory complications in preterm infants with bronchopulmonary dysplasia

BackgroundBronchopulmonary dysplasia (BPD), a common complication of premature birth, exerts considerable impact on the respiratory health of infants. This study aimed to identify the role of plasma metabolites in predicting respiratory outcomes in BPD-afflicted infants. MethodsThis was a case-control study including 15 BPD premature infants and 15 gestational age and birth weight matched no-BPD preterm infants. Plasma samples, obtained at 36 weeks postmenstrual age (PMA), were subjected to a comprehensive analysis of over 300 metabolites using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The respiratory outcomes of the infants were collected with the first 2 years of corrected postnatal age. ResultsThe analysis revealed a significant upregulation of urea and downregulation of nine metabolites in BPD infants, including oxalacetic acid, cis-aconitic acid, itaconic acid, betaine, L-asparagine, L-alanine, picolinic acid, inositol, and purine (p < 0.05). These metabolites primarily pertained to the citrate cycle (TCA cycle), glyoxylate and dicarboxylate metabolism, and alanine, aspartate, and glutamate metabolism. Furthermore, seven metabolites demonstrated substantial predictive capacity for respiratory readmissions within the first two years of corrected postnatal age, achieving an area under curve (AUC) exceeding or equal to 0.8. These included chenodeoxycholic acid, dehydrolithocholic acid, glucaric acid, D-glucuronic acid, gamma-glutamylvaline, mevalonic acid, and 3-ureidopropionic acid. ConclusionsThis study identified ten distinct plasma metabolites at 36 weeks PMA that differentiate BPD infants from their non-BPD counterparts, implicating three major metabolic pathways. Additionally, seven metabolites showed strong predictive value for heightened risk of respiratory readmission within two years, underscoring their potential utility in clinical prognostication and management strategies for BPD.

Predictors of respiratory complications in patients with C5-T5 spinal cord injuries.

Study designRetrospective chart audit.ObjectivesDescribing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5–T5 level during the initial hospitalization.SettingHospital Vall d’Hebron, Barcelona.MethodsData from patients admitted in a reference unit with acute traumatic injuries involving levels C5–T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications.ResultsWe studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). The strongest predictors of respiratory complications were: previous respiratory disease (OR 5.4, 95% CI: 1.5–19.2), complete motor function impairment (AIS A–B) (OR 4.7, 95% CI: 2.4–9.5) and concurrent chest trauma (OR 3.73, 95% CI: 1.8–7.9).ConclusionsRespiratory complications are common in traumatic spinal cord injuries between C5–T5. We identified previous respiratory disease, complete motor function impairment and the coexistence of thoracic trauma as predictors of respiratory complications. Identification of patients at risk might help clinicians to implement preventive strategies.

PREDICTORS OF RESPIRATORY COMPLICATIONS IN HOSPITALIZED PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY

Respiratory complications (RC) are common in Takotsubo cardiomyopathy (TC) and significantly account to the disease morbidity and mortality. Several factors predict worse overall TC outcomes, but predictors of RC are unknown. National estimates of adults hospitalized with a primary diagnosis of TC

Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures

Ventilatory efficiency (V˙e/V˙co2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co2 during exercise also exhibit an increased V˙e/V˙co2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p<0.05 is considered significant. Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56(74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p= 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙e/V˙co2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p= 0.02), and higher V˙e/V˙co2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p=0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor ofrespiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p= 0.01). Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

Preoperative, İntraoperative and Postoperative Predictors of Postoperative Respiratory System Complications in Patients Undergoing Open Heart Surgery

Preoperative, Intraoperative and Postoperative Predictors of Postoperative Respiratory System Complications in Patients Undergoing Open Heart SurgeryObjective: The increasing prevalence of risky cardiac operations and the changing patient profile, can cause more problems during intraoperative and postoperative periods.Problems related to the respiratory system in the postoperative period are also the most important causes of increased mortality and morbidity rates. The aim of the study was to determine the preoperative, intraoperative, and postoperative predictors of the respiratory complications of open-heart surgery patients.Material and Methods: 1401 patients undergoing open-heart surgery between 2000-2005 were evaluated retrospectively. Patients’ age, sex, body mass index, preoperative laboratory tests, left ventricular ejection fractions (LVEF, %), comorbid diseases, use of β-blockers ,smoking,type and duration of operation, cardiopulmonary bypass and anesthesia, transfusion of blood intraoperatively, time of extubation, amounts of mediastional drainage, length of stay in the ICU and in the hospital were recorded. The relationship between these predictors and postoperative respiratory complications is investigated. Results: In our study, the prevalence rate of postoperative respiratory complications among patients undergoing openheart surgery was found to be 39.2 %. The most common complication was prolonged mechanical ventilation (36.1 %), while the least frequent complication was pneumothorax (0.6 %). The mortality rate due to respiratory complications was 3.3 %. Risk factors for respiratory complications included older age, female gender, smoking, hypertension, COPD, higher rates of concomitant operations, preoperative hematologic and biochemical abnormalities, prolonged duration of CPB, anesthesia, operative, and extubation times, length of ICU and hospital stay, extra need for intraoperative transfusion of blood products and increased mediastinal drainage. Conclusion: Detailed examination of the patients preoperatively, and optimal treatment, could decrease complications of anesthesia and mortality rates by preference for the appropriate fast-tract anesthesia method which shortens duration of surgery, anesthesia and CPB.

The risk of pneumonectomy over the age of 70. A case–control study☆

A higher mortality has been reported after pneumonectomy over the age of 70. The aim of the study was to quantify the additional risk due to age after standard pneumonectomy for lung cancer by a case-control study. Our clinical database was reviewed to search for patients aged 70 years or more who underwent standard pneumonectomy for lung cancer between 1998 and 2005. A control group of patients younger than 70 (one case/two controls) was matched for sex, cardiovascular disease, American Association of Anaesthetists score, respiratory function, side of pneumonectomy, induction chemotherapy and stage. Overall mortality and morbidity were compared. Long-term survival data were also analysed. During the considered period, 35 patients aged 70 years or more underwent pneumonectomy (30 males, median age 73 years, 15 right-sided procedures). The control group was composed of 70 patients. The two groups were homogeneous in the variables used for matching. Overall mortality and morbidity were 11.4 and 54.2% in the elderly group as compared to 4.3 and 41.6% in controls (p-value not significant). Elderly patients experienced a higher rate of respiratory complications (25.7%) as compared to controls (8.3%, p=0.01). At univariate analysis, the only risk factor for death was the occurrence of respiratory complications (OR 6.5, CI 1.8-18.2). At multivariate analysis, age >or=70 years (OR 5.36, CI 1.48-19.3) and preoperative chemotherapy (OR 7.65, CI 2.04-28.6) were confirmed as predictors of respiratory complications. Five-year survival was 17.5% in the elderly group and 53.6% in the control group (p=0.003). Elderly patients with a better respiratory function (FEV1>70%) had a 5-year survival of 45.4%. In the elderly patients, the risk of respiratory complications after pneumonectomy is increased as compared to younger patients with equivalent respiratory function. Age and preoperative chemotherapy are independent risk factors for respiratory complications. A lower mortality and a better long-term survival are obtained in elderly patients with a better respiratory function (FEV1>or=70%).

Structural cardiac changes as a predictor of respiratory complications after adenotonsillectomy for obstructive breathing during sleep in children

Background and purpose To determine the association between structural cardiac changes and postoperative respiratory complications after adenotonsillectomy for obstructive breathing during sleep. Patients and methods Forty-eight children, ages 2–18 years, undergoing adenotonsillectomy for obstructive breathing during sleep were recruited for this case control study. The case group consisted of 24 children with postoperative respiratory complications after adenotonsillectomy who also had an echocardiogram. An equal number of children without postoperative respiratory complications after adenotonsillectomy were recruited as controls. Left ventricular mass (LVM) was calculated from 2D guided M mode echocardiographic measurements of the left ventricle. Left ventricular mass index (LVMI) was calculated as left ventricular mass/height 2.7. Left ventricular hypertrophy (LVH) was defined as LVMI index greater than the 95th percentile for age. The two groups were compared for demographic variables and cardiac structure. Results The two groups did not significantly differ by age, height, gender or racial distribution. LVH and right ventricular (RV) dimension greater than the 95th percentile for age remained significantly associated with the occurrence of postoperative respiratory complications after controlling for body mass index (BMI) Z score, age, gender, race, systolic and diastolic blood pressure. Conclusions The increased prevalence of structural cardiac changes in the group with complications ( P<0.01) suggests an underlying cardiac origin for postoperative respiratory complications in this group of children.

Preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection.

We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society: lung cancer surgery in patients with predictive postoperative FEV(1.0) (%FEV(1.0)ppo) > 40% and predictive postoperative diffusion capacity for carbon monoxide (%DL(co)ppo) > 40% can be carried out with average risk. We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV(1.0)), FEV(1.0)%, diffusion capacity for carbon monoxide (DL(co)), predictive postoperative FEV(1.0) (FEV(1.0)ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV(1.0) ppo, %DL(co)ppo). Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistula, prolonged air leak, arrhythmia, etc). Postoperative deaths occurred in 14 (3.9%) patients. Postoperative respiratory complications developed in 27 (7.6%) patients. Pneumonectomy (p < 0.001), preoperative chemotherapy (p < 0.01) and advanced stage (p < 0.05) were identified as risk factors of postoperative deaths. Patients undergoing lobectomy with FEV(1.0) > or = 1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEV(1.0)ppo > or = 800ml/m2 did not die of respiratory complications. Patients undergoing pneumonectomy with %FEV(1.0)ppo < 40% and %DL(co)ppo < 40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy. The values of their %DL(co)ppo were all less than 40%. By multivariate analysis, %FEV(1.0)ppo was significant independent factor associated postoperative death. We conclude that the guideline is useful for the selection for surgery of lung cancer patients. If preoperative chemotherapy is performed, the measurement of %DL(co) is recommended before surgery.

Cytology of Respiratory Epithelium as a Predictor of Respiratory Complications after Operation

A study of 111 patients undergoing elective surgery under general endotracheal anesthesia has shown that the pulmonary complication rate after operation is minimal in nonsmokers (7.9 percent) and that it rises steadily as smoking habit increases, reaching 43 percent in very heavy smokers. Peak expiratory flow rate and timed vital capacity (FEV1) were unaffected before operation except in very heavy smokers. The morphologic integrity of the ciliated tracheobronchial epithelial cells seen in smears obtained within ten minutes of the onset of anesthesia and quantitated by a scoring system, deteriorates progressively with increasing smoking habit and constitutes the most sensitive index for the prediction of diminished resistance to the stress of anesthesia and operation and of incipient chronic obstructive lung disease in smokers.