Рossibility Prediction of Critical Incident during Elective Surgery in Abdominal Surgery

K.A. Tsygankov, A.V. Shchegolev, D.A. Averianov, S.V. Bokatyuk

FGBVOU VPO «Military-Medical Academy n.a. C.M. Kirov» MO RF, St. Petersburg

For citation: Tsygankov KA, Shchegolev AV, Averianov DA, Bokatyuk SV. Critical Incident Prediction Рossibility in Elective Abdominal Surgery. Intensive Care Herald. 2016;2:80–84. 


Тhe aim of the study. This article describes a method of prediction of critical incidents. Materials and methods. In the study 52 patients were included, mean age was 61 (55; 68) years. The physical status classification ASA II 39 patients (75 %), ASA III — 13 patients (25 %). In the preoperative period, patients performed a six-minute test and a questionnaire filled daily activities of Duke. The next day performed cardiorespiratory exercise testing. To perform this test using «Ultima CPX» company Medical Graphics (USA) system. On stage, the anesthesia monitoring of critical incidents and use of statistical methods is determined which of the indexes has the highest predictive value. Results. Using logistic regression revealed the possibility of prediction of critical incidents using the anaerobic threshold and the six-minute test. In constructing the ROC-curve is obtained that the low sensitivity and specificity of the six-minute test does not allow the use of this method for predicting the development of critical incidents, in contrast, the anaerobic threshold testified to the high probability of critical incidents. The area of the curve was 0.991. The significance of the area (p < 0.05) showed the usefulness of anaerobic threshold to determine the likelihood of critical incidents. From the curve coordinate table we found that the threshold sensitivity of 100 % and specificity of 95 % is the value of 10.85 ml/kg/min. Given the data rate of the critical analyzed incidents resulting revealed that patients with less anaerobic threshold 10.85 ml/kg/min developed 36 (85.7 %) of the critical stages of anesthesia incidents, and in patients with more anaerobic threshold 10.85 ml/kg/min, only 6 (14.2 %). Conclusions. These results confirm the possibility of prediction of critical incidents in the preoperative period with the help of the anaerobic threshold.

Keywords: preoperative examination, functional status, cardiorespiratory exercise test, anaerobic threshold, critical incidents

Received: 18.04.2016


References

  1. Виноградов В.Л. Протоколы проведения общей анестезии и регулярный внутренний аудит как составные элементы безопасности анестезиологического обеспечения больных с термическими: Дис. … д-ра мед. наук. М., 2002.
  2. Кулагина Т.Ю., Стамов В.И., Никода В.В. Кардиореспираторные нагрузочные тесты в предоперационной оценке хирургического риска у больных старшего возраста. Анестезиология и реаниматология. 2013; 2: 25–29.
  3. Терехова Н.Н., Казакова Е.А., Ситников А.В. Проведение внутреннего аудита на основе регистрации критических инцидентов: первые результаты. Анестезиология и реаниматология. 2005; 2: 33.
  4. Щеголев А.В. Анализ частоты критических инцидентов при плановых оперативных вмешательствах на органах брюшной полости. Вестник Российской военно-медицинской академии. 2016; 1(53): 29–32.
  5. Agnew N. Preoperative cardiopulmonary exercise testing. Continuing Education in Anaesth. Crit. Care & Pain. 2010; 10(2): 33–37.
  6. Andersson C., Gislason G.H. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery. Eur. J. Heart Fail. 2014; 16(12): 1310–1316.
  7. ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med. 2002; 166: 111–117.
  8. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am. J. Respir. Crit. Care Med. 2003; 167: 211–277.
  9. Boersma E. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am. J. Med. 2005; 118: 1134–1141.
  10. George M.J. The value of the Duke Activity Status Index (DASI) in predicting ischaemia in myocardial perfusion scintigraphy — a prospective study. Nucl. Med. Rev. Cent. East Eur. 2010; 13(2): 59–63.
  11. Goodyear S.J., Yow H., Saedon M. Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study. Perioper. Med. 2013; 2(1): 2–10.
  12. Hennis P.J. Cardiopulmonary exercise testing predicts postoperative outcome in patients undergoing gastric bypass surgery. Br. J. Anaesth. 2012; 109(4): 566–571.
  13. Jose L., Maurizio S. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur. Heart J. 2014; 35: 2383–
  14. Older P., Smith R. Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth. Intensive Care. 1988; 16: 395–398.
  15. Older P. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest. 1999; 166(2): 355–362.
  16. Runciman W.B. The australian incident monitoring study. Errors, incidents and accidents in anaesthetic practice. Anaesth. Intensive Care. 1993; 21: 506–519.
  17. Shoemaker W.C., Appel P.L., Kram H.B., Waxman K. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1998; 94(6): 1176–1186.
  18. Struthers R. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. Br. J. Anaesth. 2008; 101(6): 774–780.
  19. Stringer W., Casaburi R., Older P. Cardiopulmonary exercise testing: does it improve perioperative care and outcome? Curr. Anaesthesiol. 2012; 25(2): 178–184.