Supplemental digital content to ‘Epidemiology, Practice of Ventilation and Outcome for Patients at Increased Risk of Postoperative Pulmonary Complications – LAS VEGAS, an Observational Study in 29 Countries’ Content Page 2 – 10 List of LAS VEGAS study Network Collaborators Page 11 – 13 STROBE Statement checklist Page 14 Randomization Procedure Page 15 eTable 1. ARISCAT score Page 16 – 19 eTable 2. Full list of participating centres Page 20 eTable 3. Hospital characteristics of participating centres Page 21 eTable 4. Patient and surgical characteristics 2 Page 22 eTable 5. Severe postoperative pulmonary complications Page 23 eTable 6. Patient and surgical characteristics (ARISCAT scores: low, moderate, high) Page 24 eTable 7. Intraoperative ventilation characteristics (ARISCAT scores: low, moderate, high) Page 25 eTable 8. Patient outcomes (ARISCAT scores: low, moderate, high) Page 26 eFigure 1. Ventilation parameters in patients at low, moderate, high risk of PPC Page 27 eFigure 2. Scatterplots showing ventilator combinations of patients at low, moderate, high risk of PPC Page 28 References 1
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Supplemental digital content to ‘Epidemiology, Practice of Ventilation and Outcome for Patients at
Increased Risk of Postoperative Pulmonary Complications – LAS VEGAS, an Observational Study in 29
Countries’
ContentPage 2 – 10 List of LAS VEGAS study Network Collaborators Page 11 – 13 STROBE Statement checklistPage 14 Randomization ProcedurePage 15 eTable 1. ARISCAT scorePage 16 – 19 eTable 2. Full list of participating centres Page 20 eTable 3. Hospital characteristics of participating centresPage 21 eTable 4. Patient and surgical characteristics 2Page 22 eTable 5. Severe postoperative pulmonary complicationsPage 23 eTable 6. Patient and surgical characteristics (ARISCAT scores: low, moderate, high)Page 24 eTable 7. Intraoperative ventilation characteristics (ARISCAT scores: low, moderate, high)Page 25 eTable 8. Patient outcomes (ARISCAT scores: low, moderate, high)Page 26 eFigure 1. Ventilation parameters in patients at low, moderate, high risk of PPCPage 27 eFigure 2. Scatterplots showing ventilator combinations of patients at low, moderate, high risk of PPCPage 28 References
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List of LAS VEGAS study Network Collaborators
Austria
LKH Graz, Graz: Wolfgang Kroell, Helfried Metzler, Gerd Struber, Thomas Wegscheider
AKH Linz, Linz: Hans Gombotz
Medical University Vienna: Michael Hiesmayr, Werner Schmid, Bernhard Urbanek
Belgium
UCL - Cliniques Universitaires Saint Luc Brussels: David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu
Universitary Hospital Brussels (UZ Brussel): Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen
Het Ziekenhuis Oost Limburg (ZOL), Genk: Dimitri Dylst, Jeroen van Melkebeek, Maud Beran
Ghent University Hospital, Gent: Stefan de Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann De Bruyne
Maria Middelares, Gent: Stijn van de Velde
European Society of Anaesthesiology, Brussels: Brigitte Leva, Sandrine Damster, Benoit Plichon
Bosnia and Herzegovina
General Hospital “prim Dr Abdulah Nakas” Sarajevo: Marina Juros-Zovko, Dejana Djonoviċ- Omanoviċ
Croatia
General Hospital Cakovec, Cakovec: Selma Pernar
General Hospital Karlovac, Karlovac: Josip Zunic, Petar Miskovic, Antonio Zilic
University Clinical Hospital Osijek, Osijek: Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric
University Hospital Rijeka, Rijeka: Kazimir Juricic, Vedran Frkovic
General Hospital Dr J Bencevic, Slavonski Brod: Jasminka Kopic, Ivan Mirkovic
University Hospital Center Split, Split: Nenad Karanovic, Mladen Carev, Natasa Dropulic
University Hospital Sveti Duh, Zagreb: Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic
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University Hospital, Medical school, “Sestre milosrdnice” (Sister of Charity), Zagreb: Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna
Sehovic
Czech Republic
University Hospital Brno, Brno: Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab
University Hospital Hradec Kralove, Hradec Kralove: Jan Brujevic, Katerina Vitkova, Katerina Jirmanova
University Hospital Ostrava, Ostrava: Ivana Volfova, Paula Dzurnakova, Katarina Liskova
Azienda Ospedaliera – Universitaria Sant’Anna, Ferrara: Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari
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Ospedali Riuniti Di Foggia - University of Foggia, Foggia: Gilda Cinnella, Pasquale Raimondo, Daniela La Bella, Lucia Mirabella, Davide D'antini
IRCCS AOU San Martino IST Hospital, University of Genoa, Genoa: Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo,
Stefano Pezzatto, Luca Montagnani
IRCCS San Raffaele Scientific Institute, Milano: Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia Di Parma, Valentina Tarzia, Roberto Dossi,
Marta Eugenia Sassone
Istituto europeo di oncologia – ieo, Milano: Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino
Ospedale Niguarda Ca'Granda Milano, Milano: Ines Arpino, Sara Sher
Ospedale San Paolo - University of Milano, Milano: Concezione Tommasino, Francesca Rapido, Paola Morelli
University of Naples “Federico II” Naples: Maria Vargas, Giuseppe Servillo
Medical University Hospital, Hospital of Lithuanian University of Health Sciences, Kaunas: Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute
Vilnius University Hospital - Institute of Oncology, Vilnius: Renatas Tikuisis, Povilas Miliauskas
Vilnius University Hospital - Santariskiu Clinics, Vilnius: Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute
5
Malta
Mater Dei Hospital, Msida: John Xuereb, Maureen Bezzina, Francis Joseph Borg
Netherlands
Academic Medical Centre, University of Amsterdam: Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Jan Binnekade, Lieuwe Bos
VU University Medical Center, Amsterdam: Christa Boer, Anne Duvekot
MC Haaglanden, Den Haag: Bas in ‘t Veld, Alice Werger, Paul Dennesen, Charlotte Severijns
Westfriesgasthuis, Hoorn: Jasper De Jong, Jens Hering, Rienk van Beek
Norway
Haukeland University Hospital, Bergen: Stefan Ivars, Ib Jammer
Førde Central Hospital /Førde Sentral Sykehus, Førde: Alena Breidablik
Martina Hansens Hospital, Gjettum: Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos
Bærum Hospital, Vestre Viken, Rud: Jannicke Mellin-Olsen, Elisabeth Andersson
Stavanger University Hospital, Stavanger: Amir Shafi-Kabiri
Panama
Hospital Santo Tomás, Panama: Ruby Molina, Stanley Wutai, Erick Morais
Portugal
Hospital do Espírito Santo - Évora, E.P.E, Évora.: Gloria Tareco, Daniel Ferreira, Joana Amaral
Centro Hospitalar de Lisboa Central, E.P.E, Lisboa.: Maria de Lurdes Goncalves Castro, Susana Cadilha, Sofia Appleton
Centro Hospitalar de Lisboa Ocidental, E.P.E. Hospital de S. Francisco Xavier, Lisboa: Suzana Parente, Mariana Correia, Diogo Martins
Santarem Hospital, Santarem: Angela Monteirosa, Ana Ricardo, Sara Rodrigues
Reanimatology Research Institute n.a. Negovskij RAMS, Moscow: Valery Likhvantsev, Sergei Fedorov
Serbia
Clinical Center of Vojvodina, Emergency Center, Novisad: Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic
Slovakia
National Cancer Institute, Bratislava: Zuzana Kusnierikova, Maria Zelinkova
F.D. Roosevelt teaching Hospital, Banská Bystrica: Katarina Bruncakova, Lenka Polakovicova
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Faculty Hospital Nové Zámky, Nové Zámky: Villiam Sobona
Slovenia
Institute of Oncology Ljubljana, Ljubljana: Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar
University Medical Centre Ljubljana, Ljubljana: Jasmina Markovic-Bozic, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel
Spain
Hospital Sant Pau, Barcelona: Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava
Hospital Universitari Germans Trias I Pujol, Barcelona: Jaume Canet, Enrique Moret, Monica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas
University of Navarra, Pamplona: Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martinez Simon, Ana de Abajo Larriba
Dokuz Eylül Universitesi Tip Fakültesi, Izmir: Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Sule Ozbilgin
Şifa University Hospital, İzmir: Jale Maral, Seyda Canli
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Selcuk University faculty of medicine, Konya: Oguzhan Arun, Ali Saltali, Eyup Aydogan
Fatih Sultan Mehmet Eğitim Ve Araştirma Hastanesi, Istanbul: Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman
Ukraine
Institute Of Surgery And Transplantology, Kiev: Andriy Mazur
Zaporizhzhia State Medical University, Zaporizhzhia: Sergiy Vorotyntsev
United Kingdom
SWARM Research Collaborative: for full list of SWARM contributors please see www.ukswarm.com
Northern Devon Healthcare NHS Trust, Barnstaple: Guy Rousseau, Colin Barrett, Lucia Stancombe
Golden Jubilee National Hospital, Clydebank, Scotland: Ben Shelley, Helen Scholes
Darlington Memorial Hospital, County Durham and Darlington Foundation NHS Trust, Darlington: James Limb, Amir Rafi, Lisa Wayman, Jill Deane
Royal Derby Hospital, Derby: David Rogerson, John Williams, Susan Yates, Elaine Rogers
Dorset County Hospital, Dorchester: Mark Pulletz, Sarah Moreton, Stephanie Jones
The Princess Alexandra NHS Hospital Trust, Essex: Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall
Royal Devon and Exeter NHS Foundation Trust, Exeter: Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre
Hospital James Paget University Hospital NHS Foundation Trust, Great Yarmouth: Michael Lundberg, Lynn Everett, Helen Nutt
Royal Surrey County Hospital NHS Foundation Trust, Guildford: Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown
Kettering General Hospital NHS Foundation Trust, Kettering: Philip Watt, Parizade Raymode
Barts Health NHS Trust, Royal London Hospital, London: Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary
Newcastle Upon Tyne Hospitals NHS Trust The Freeman Hospital High Heaton, Newcastle upon Tyne: Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain,
Sarah Gibb, Stephen Mowat
Derriford Hospital Plymouth Hospitals NHS Trust, Plymouth: Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd
Royal Hallamshire Hospital, Sheffield: Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts
Mid Staffordshire NHS, Stafford: Moses Chikungwa, Clare Jackson
Musgrove Park Hospital, Taunton: Andrew Donovan, Jayne Foot, Elizabeth Homan
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South Devon Healthcare NHS Foundation Trust /Torbay Hospital, Torquay, Torbay: Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer
Royal Cornwall Hospital, Truro: Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch
Mayo Clinic, Rochester: Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze
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STROBE Statement checklist
Item No. Recommendation
Page No.
Title and abstract 1 (a) Indicate the study’s design with a commonly used term in the title or the abstract 1
(b) Provide in the abstract an informative and balanced summary of what was done and what was found 4,5
IntroductionBackground/rationale 2 Explain the scientific background and rationale for the investigation being reported 6
Objectives 3 State specific objectives, including any pre–specified hypotheses 7
MethodsStudy design 4 Present key elements of study design early in the paper 9 - 11
Setting 5 Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection 8 – 11Supplement p. 15
Participants 6 (a) Cohort study—Give the eligibility criteria, and the sources and methods of selection of participants. Describe methods of follow-up
9 - 11Supplement p. 14
(b) Cohort study—For matched studies, give matching criteria and number of exposed and unexposed n.a.
Variables 7 Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable
10, 11
Data sources/ measurement
8* For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group
10, 11
Bias 9 Describe any efforts to address potential sources of bias 8 – 12
Study size 10 Explain how the study size was arrived at 9
Continued on next page
11
Quantitative variables 11 Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why
11 – 13
Statistical methods 12 (a) Describe all statistical methods, including those used to control for confounding 11 – 14
(b) Describe any methods used to examine subgroups and interactions 10 – 11
(c) Explain how missing data were addressed -
(d) Cohort study—If applicable, explain how loss to follow-up was addressed 13
(e) Describe any sensitivity analyses x
ResultsParticipants 13* (a) Report numbers of individuals at each stage of study—e.g. numbers potentially eligible, examined for eligibility,
confirmed eligible, included in the study, completing follow-up, and analysed15, fig.1
(b) Give reasons for non-participation at each stage 15, fig.1
(c) Consider use of a flow diagram fig.1
Descriptive data 14* (a) Give characteristics of study participants (e.g. demographic, clinical, social) and information on exposures and potential confounders
15 – 17, tab 1, eTab 3
(b) Indicate number of participants with missing data for each variable of interest tab 1 – 4, eTab 4, 6 – 8
(c) Cohort study—Summarise follow-up time (e.g., average and total amount) 15 – 17, Fig 4
Outcome data 15* Cohort study—Report numbers of outcome events or summary measures over time 15 – 17, tab 2, 3, 4
Main results 16 (a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (e.g., 95% confidence interval). Make clear which confounders were adjusted for and why they were included
n.a.
(b) Report category boundaries when continuous variables were categorized tab 1, 2, eTab 4, 6 – 8
(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period x
Continued on next page
12
Other analyses 17 Report other analyses done - e.g. analyses of subgroups and interactions, and sensitivity analyses n.a.
Discussion
Key results 18 Summarise key results with reference to study objectives 18
Limitations 19 Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias
21, 22
Interpretation 20 Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence
18 – 21
Generalisability 21 Discuss the generalisability (external validity) of the study results 18, 19
Other information
Funding 22 Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based
24
13
14
Randomization procedure
Centres with >180 eligible patients per week are offered the option to reduce their patient cohort by
randomization. These centres are identified according to the number of eligible patients per week, as reported in
the LAS VEGAS Site Survey.
Distribution:
< 180 procedures per week: no randomization
180 – 360 procedures per week: randomization to include 50% of their cohort
> 360 procedures per week: randomization to include 25% of their cohort
Only eligible, planned patients are suitable for randomization. All Emergency procedures and all procedures
performed outside office hours (evening/ night/weekend) must be included and therefore should not enter the
randomization program.
Details on randomization:
- Randomization program: ALEA (computerized)
- Stratified per centre
- 1 inlog provided per centre
- Random blocks
- Variables collected:
*Center name
*Date of surgery
*Urgency of procedure
*Surgical Procedure (same categories as collected in CRF)
*Planned duration of surgery (in hours)
*Age patient (in years)
*ASA score (1 to 5 or not available)
- Output: INCLUDE vs EXCLUDE
15
eTable 1. ARISCAT risk score 1
Independent predictors of risk for postoperative pulmonary complications identified in logistic regression modelmultivariate analysis ß-coefficients risk score†
Age (years)
≤ 50 1
51 – 80 1.4 (0.6 - 3.3) 0.331 3
> 80 5.1 (1.9 - 13.3) 1.619 16
Preoperative SpO2 (%)
≥ 96 1
91 – 95 2.2 (1.2 - 4.2) 0.802 8
≤ 90 10.7 (4.1 - 28.1) 2.375 24
Respiratory infection in the last month 5.5 (2.6 - 11.5) 1.698 17
Abbreviations: CI, confidence interval; OR, odds ratio; SpO2, oxyhaemoglobin saturation by pulse oximetry breathing air in supine position† The simplified risk score was the sum of each logistic regression coefficient multiplied by 10, after rounding off its value
16
eTable 2. Full list of participating centresCountry City Institution #
PatientsAustria Graz LKH Graz 51
Austria Linz AKH Linz 40
Austria Vienna Medical University Vienna 34
Belgium Brussels UCL - Cliniques Universitaires Saint Luc Brussels 119
Data is presented as: median [QR] or proportion (n/N); Increased versus high risk for PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia risk (ARISCAT) score (< versus ≥ 26, respectively); *Laboratory values: haemoglobin was collected when available from collection within routine care; white blood cell count and creatinine were collected when available from collection within routine care; PRBC: packed red blood cells
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eTable 5. Severe postoperative pulmonary complications
Variable All patients Low risk of PPCs Increased risk of PPCs
Total severe PPCs## 2.8 (270/9697) 1.6 (104/6675) 14.5 (156/2632) 3.98 (3.09 – 5.12) < 0.001
All data is presented as proportion, % (n/N); Comparison of differences within a subgroup is performed by using the t-test for continuous variables and Chi-square for categorical variables; CI: confidence interval; Low versus increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia risk (ARISCAT) score (< versus ≥ 26, respectively); PPCs: Postoperative pulmonary complications; #Total PPCs: one patient could present with multiple PPCs, but was scored only once (YES or NO principle); ##Total severe PPCs: same composite as total PPCs, without unplanned supplemental O2
23
eTable 6. Patient and surgical characteristics (ARISCAT low, moderate, high)
ARISCAT < 26(n = 6743)
ARISCAT 26–44(n = 2215)
ARISCAT ≥ 45(n = 455)
Patient characteristics
Male sex 2937 / 6743 (43.6)1067 / 2215 (48.2) 227 / 455 (49.9)
Duration of surgery (min)† 60 (35–95)125 (75–193) 157 (91–220)
Duration of anaethesia (min)†† 90 (60–128)165 (105–240) 205 (130–280)
Data is presented as: median (QR) or proportion (n/N); Low, moderate, versus high risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia risk (ARISCAT) score (< 26, 26 – 44, versus ≥ 45, respectively); BMI: Body Mass Index; ASA: American Society of Anaesthesiology; SpO2: Peripheral Oxygen Saturation; COPD: Chronic Obstructive Pulmonary Disease; *Neuromuscular disease affecting the respiratory system; §Vascular surgery is carotid endarterectomy, aortic surgery and peripheral vascular taken together; #Urgency of surgery: elective: surgery that is scheduled in advance because it does not involve a medical emergency, urgent: surgery required within < 48 hours, emergency: non-elective surgery performed when the patient's life or well-being is in direct jeopardy; †Duration of surgery is the time between skin incision and closure of the incision. ††Duration of anaesthesia is the time between start induction and extubation or discharge from operation room if mechanical ventilation remained.
$ 390 / 6675 (5.8) 315 / 2184 (14.4) 93 / 448 (20.8) 2.72 (2.32 – 3.18) < 0.001 4.22 (3.29 – 5.42) < 0.001 Respiratory failure 60 / 6675 (0.9) 70 / 2184 (3.2) 20 / 448 (4.5) 3.65 (2.58 – 5.17) < 0.001 5.15 (3.08 – 8.63) < 0.001 Invasive MV 41 / 6675 (0.6) 42 / 2184 (1.9) 19 / 448 (4.2) 3.17 (2.06 – 4.89) < 0.001 7.17 (4.12 – 12.45) < 0.001 ARDS 1 / 6675 (0.0) 4 / 2184 (0.2) 4 / 448 (0.9) 12.25 (1.37 – 109.62) 0.025 60.13 (6.71 – 439.07) < 0.001 Pneumonia 10 / 6675 (0.1) 17 / 2184 (0.8) 11 / 448 (2.5) 5.23 (2.39 – 11.44) < 0.001 16.78 (7.09 – 39.72) < 0.001 Pneumothorax 8 / 6675 (0.1) 2 / 2184 (0.1) 2 / 448 (0.4) 0.76 (0.16 – 3.60) 0.733 3.74 (0.79 – 17.65) 0.096Postoperative outcome Hospital Length of Stay 1 (0–3) 4 (1–7) 5 (2–8) --- --- --- --- In-hospital mortality 13 / 6163 (0.2) 26 / 2034 (1.3) 15 / 411 (3.6) 6.12 (3.14 – 11.94) < 0.001 17.92 (8.47 – 37.92) < 0.001 Hospital-free days* 26 (24–27) 23 (21–26) 22 (20–25) --- --- --- ---All data is presented as proportion, % (n/N) or median (QR); Comparison of differences within a subgroup is performed by using the t-test for continuous variables and Chi-square for categorical variables; CI: confidence interval; Low, moderate, versus high risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia risk (ARISCAT) score (< 26, 26 – 44, versus ≥ 45, respectively); Definitions intraoperative events: Any de–saturation: defined as occurrence of SpO2 < 92%; Unplanned recruitment manoeuvre: ventilation strategies aimed to restore lung aeration; ventilation pressure reduction: ventilation strategies aimed to lower peak and/or plateau pressures; Expiratory flow limitation: defined as expiratory flow higher than zero at end-expiration as suggested by visual analysis of the flow curve; Hypotension: defined as SAP < 90mmHg for 3 min or longer; Need for vaso-active drugs: any vaso-active drug given to correct hypotension; New onset arrhythmias: defined as new onset of atrial fibrillation, sustained ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation. PPCs: Postoperative pulmonary complications; NIV: non-invasive ventilation by mask or helmet; MV: mechanical ventilation; ARDS: the acute respiratory distress syndrome; LOS: length of hospital stay; PPCs: on day 1 to 5 were scored YES as soon as the event occurred on either ward or intensive care unit; #Total PPCs: one patient could present with multiple PPCs, but was scored only once (YES or NO principle); ##Total severe PPCs: same composite as total PPCs, without unplanned supplemental O 2; $unplanned supplementary O2: supplemental oxygen administered due to PaO2 < 8 kPa or SpO2 < 90% in room air, excluding oxygen supplementation given as standard care (e.g. directly after arrival in the PACU; *Hospital-free days when discharged and alive at day 28.
27
eFigure 1. Ventilation parameters in patients at low, moderate, and high risk of PPC
A) Cumulative frequency distribution of tidal volume; B) cumulative frequency distribution of positive end–expiratory pressure; C) cumulative distribution of peak pressure; D) cumulative distribution of driving pressure. Abbreviations: PPC: postoperative pulmonary complications; PEEP: positive end–expiratory pressure; PBW: predicted body weight; VT: tidal volume
28
eFigure 2. Scatterplots showing ventilator combinations of patients at low, moderate, high risk of PPC
Scatterplot showing distribution of: A) tidal volume– positive end–expiratory pressure combinations; B) tidal volume– peak pressure; C) tidal volume– respiratory rate; D) tidal volume– driving pressure in patients at low, moderate, and high risk of PPC.Hourly–collected data were averaged per patient and presented as medians for tidal volume (expressed in mL/kg predicted body weight) and positive end–expiratory pressure (expressed in cm H2O)Abbreviations: PPC: postoperative pulmonary complications; VT, tidal volume; PBW, predicted body weight; PEEP, positive end–expiratory pressure, bpm: breaths per minute
29
References
1. Canet J, Gallart L, Gomar C, et al. Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort. Anesthesiology 2010; 113: 1338-50