RESPIRATORY RISK IN NON-CARDIAC SURGERY


I. Estimating risk: The "Respiratory Failure Risk Index"

Converting points to "Respiratory Failure Risk Index Class":

Point Total Class Predicted probability of PRF
< 11 1 0.5%
11-19 2 2.2%
20-27 3 5.0%
28-40 4 11.6%
>40 5 30.5%

II. Reducing risk of respiratory complications of surgery: Interventions with good evidence of benefit (reducing incidence of atelectasis and pneumonia) per a systematic review (Ann. Int. med. 144:596, 2006):

  1. Postoperative lung expansion (e.g. incentive spirometry, deep breathing exercoses, or CPAP)
  2. Selective postoperative nasogastric decompression (i.e. use only for postoperative nausea or vomiting, inability to tolerate PO intake, or symptomatic abdominal distension)
  3. Short-acting, as opposed to long-acting, neuromuscular blockade