A predictive Score for Pulmonary Complications in Mechanically Ventilated Patients in a Surgical Intensive Care Unit
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Abstract
Background: Two-thirds of patients in a surgical intensive care unit (SICU)require mechanical ventilation. However, pulmonary complications and its associated risk factors are not adequately identified in these patients. Objectives: To identify the risk factors and to develop a predictive score for pulmonary complications in mechanically ventilated patients in a SICU. Methods: Mechanically ventilated patients admitted to a SICU were included in this prospective study. The onset of pulmonary complications within seven days after mechanical ventilation support was observed. A multivariate analysis with a logistic regression model was used to identify variables associated with the development of pulmonary complications and a predictive score was subsequently developed. Results: There were 306 patients included in this study and of these, 36.6% experienced pulmonary complications during the study period. An abnormal chest radiograph, hypoalbuminemia, and presence of respiratory, cardiovascular, and renal dysfunction upon SICU admission were the independent risk factors identified. The area under the receiver-operating characteristic curves for the predictive score was 0.768 (95% CI, 0.713-0.822). The best cut-off value was 8.5, which yielded 71.4% (95% CI, 62.1-79.6%) sensitivity and 71.7% (64.8-77.9%) specificity. Conclusion: The incidence of pulmonary complications among mechanically ventilated patients in a SICU is high. Five independent risk factors were identified, and a new predictive score was developed which had a fair discriminative power. Further external validation is needed to verify its accuracy.
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