Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

FIGURE 21 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 21. Pedinotus glabroscutum sp. nov. (female, holotype). A, Habitus, lateral view. B, Basal segments of antenna. C, Head, front view. D, Head, dorsal view. E, Head, lateral view. F, Apex of ovipositor. G, Mesosoma, dorsal view. H, Mesosoma, lateral view. I, Propodeum and first metasomal tergite, dorsal view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 47, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 35 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 35. Pedinotus pardalotus Marsh (female, holotype). A, Habitus, lateral view. B, Head and mesosoma, lateral view. C, Head and mesoscutum, dorsal view. D, Metasoma, dorso-lateral view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 72, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 32 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 32. Pedinotus nitidus sp. nov. (female, holotype). A, Habitus, dorsal view. B, Head, front view. C, Head, dorsal view. D, Head, lateral view. E, Basal segments of antenna. F, Apical segments of antenna. G, Mesosoma, dorsal view. H, Mesosoma, lateral view. I, Hind leg, lateral view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 67, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 36 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 36. Pedinotus peruanus sp. nov. (female, holotype). A, Habitus, lateral view. B, Head, front view. C, Head and mesoscutum, dorsal view. D, Mesosoma, lateral view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 75, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 45 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 45. Pedinotus subtristis sp. nov. (female, holotype). A, Wings. B, Metasoma, dorsal view. C, Metasoma, lateral view. D, Apex of ovipositor.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 90, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 31 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 31. Pedinotus nigriceps sp. nov. (female, holotype). A, Wings. B, Metasoma, dorsal view. C, Metasoma, lateral view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 64, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt

FIGURE 7 in Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)

FIGURE 7. Pedinotus brunniventris sp. nov. (female, holotype). A, Wings. B, Metasoma, dorsal view. C, Metasoma, lateral view.Published as part of &lt;i&gt;Belokobylskij, Sergey A., Castro, Clóvis Sormus De, Shimbori, Eduardo Mitio, Zaldívar-Riverón, Alejandro, Penteado-Dias, Angélica Maria &amp; Braet, Yves, 2017, Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae), pp. 1-102 in Zootaxa 4327 (1)&lt;/i&gt; on page 21, DOI: 10.11646/zootaxa.4327.1.1, &lt;a href="http://zenodo.org/record/10070480"&gt;http://zenodo.org/record/10070480&lt;/a&gt