Tuesday August 5, 2008
Can we predict who needs ICU admission after Major Lung Resection


Study by Brunelli and his associates helped to address that issue.

Background: We aimed to develop and validate a scoring system to predict intensive care unit (ICU) admission for complications after major lung resection for purposes of optimizing planning of resources for patient care.

Methods: Patients undergoing major lung resections performed between 2000 and 2006 at three thoracic surgery units were analyzed for unplanned admission to the ICU for complications. Variables were initially screened by univariate analysis. Selected variables were used in a stepwise logistic regression analysis that was validated by bootstrap analysis. The scoring system was developed by proportional weighting of the significant and reliable predictors estimates and validated on patients operated on in a different center.

ResuIts: In the derivation set of 1927 patients, 82 had ICU admission for complication, and 30 died (associated mortality rate 36.5%). Predictive variables and their scores were

* 2 points - pneumonectomy; and
* 1 point each for

• age older than 65,
• predicted post operative FEV1 below 65%,
• predicted post operative DLCO below 50%, and
• cardiac comorbidity
  

Patients were grouped into three classes based on their score, which were significantly associated with the incremental risk of ICU admission in the validation set of 349 patients.

Conclusion: It helps us in assessing and preparing for the post operative need for ICU and possible complications.

Reference:

Brunelli A, Ferguson MK, Rocco G, Pieretti P, et al. A Scoring System Predicting the Risk for Intensive Care Unit Admission for Complications After Major Lung Resection: A Multicenter Analysis. Ann Thorac Surg 2008;86:213-218.