Risk Assessment of Perioperative Respiratory Adverse Events and Validation of the COLDS Score in Children with Upper Respiratory Tract Infection.

Background and objectives: Children are at greater risk of upper respiratory tract infection (URTI), which can pose a higher risk of perioperative respiratory adverse events (PRAEs), than adults. The purpose of this study was to validate the COLDS score as a pre-anesthetic risk assessment tool for predicting the possibility of PRAEs. Materials and methods: Children aged under 18 years and undergoing elective surgery were retrospectively included. Logistic regression analysis and the area under the receiver-operating characteristic (ROC) curve (AUC) were used to estimate the ability of the COLDS score to predict PRAEs. Propensity-matched comparison was evaluated using the cut-off value from the ROC curve. Results: Among the 6252 children, 158 children had a recent URTI and 34 cases of PRAEs were reported. Age, current symptoms, and COLDS score were found to be significant variables in predicting PRAEs. From the ROC curve, values of 0.652 (p = 0.007) for AUC and 12.5 for the cut-off value of the COLDS score were calculated. Propensity-matched comparison revealed that each and every component of COLDS contributed to the higher COLDS score group. In addition to higher COLDS score, younger age and current URTI symptoms were found to be significant risk factors for PRAEs. Conclusions: This study validated the predictive power of COLDS score as a risk assessment tool for children with URTI undergoing elective surgery under general anesthesia.

Perioperative Transthoracic Lung Ultrasound for Assessment of Pulmonary Outcome in Adolescent Idiopathic Scoliosis Patients: Prospective, Observational Pilot Study.

The purpose of study was to evaluate the perioperative lung ultrasound findings of patients undergoing scoliosis correction. LUS examination was performed examined three 3 times for each patient: 20 min after starting mechanical ventilation of the lungs(preoperative), after surgery when the patient was placed in the supine position(postoperative), and 20 min after arrival in the post-anaesthesia care unit. Arterial blood gas analyses, mechanical ventilation parameters, peripheral oxygen saturation(SpO2) were also checked. Twenty-six patients completed the study. The changes of LUS score(20 min) was significantly negatively correlated with the partial pressure of arterial oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio change(P = 0.039, r = -0.40). The change in mean convex side LUS score was significantly greater than that of the concave side as determined by two-factor repeated measures analysis of variance(p = 0.001). Multiple regression analysis revealed perioperative LUS change was the significant factor related to the oxygen index change (p = 0.042). One case of pneumothorax was diagnosed and pleural thickening more than 5 mm was detected in 8 patients and five patients of those were diagnosed pleural effusion and performed thoracentesis after surgery. Postoperative increase of LUS score was related with deteriorating of oxygenation at one day after surgery, and it suggests that lung ultrasound allows prediction of postoperative hypoxia and facilitates the diagnosis of pulmonary complications at operation room in AIS patients.

Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: a prospective randomized controlled trial.

PURPOSE: Recent studies have shown the potential benefits of pressure-controlled ventilation-volume guaranteed (PCV-VG) compared to volume-controlled ventilation (VCV), but the results were not impressive. We assessed the effects of PCV-VG versus VCV in elderly patients by using lung ultrasound score (LUS). PATIENTS AND METHODS: Elderly patients (aged 65-90 years) scheduled for hip joint surgery were randomly assigned to either the PCV-VG or VCV group during general anesthesia. LUS and mechanical ventilator parameters were evaluated before induction, 30 mins after a semi-lateral position change, during supine repositioning before awakening, and 15 mins after arrival to the post-anesthesia care unit (PACU). Pulmonary function tests were performed before and after surgery. Other recovery indicators were also assessed in the PACU. RESULTS: A total of 76 patients (40 for PCV-VG and 36 for VCV) were included this study. Demographic data showed no significant difference between the two groups. In both groups, LUSs before induction were significantly lower than those at other time points. LUSs of the VCV group were significantly increased during perioperative periods compared with the PCV-VG group (p=0.049). Visualized LUS modeling suggested an intuitive difference in the two groups and unequal distribution in lung aeration. Higher dynamic compliance and lower inspiratory peak pressure were observed in the PVC-VG group compared to the VCV group (33.54 vs 27.36, p<0.001; 18.93 vs 21.19, p<0.001, respectively). Postoperative forced vital capacity of the VCV group was lower than that of PCV-VG group, but this result was not significant (2.06 vs 1.79, respectively; p=0.091). The other respiratory data are comparable between the two groups. CONCLUSION: The PCV-VG group showed better LUS compared with the VCV group. Moreover, LUS modeling in both groups suggests non-homogeneous and positional change in lung aerations during surgery. CLINICAL TRIAL REGISTRATION: This study was registered at the UMIN clinical trials registry (unique trial number: UMIN000029355; registration number: R000033510).