Abstract
Les complications respiratoires sont les complications les plus fréquentes après chirurgie de l’aorte abdominale. Les épreuves fonctionnelles respiratoires (EFR) et les gaz du sang artériel (GDS) sont fréquemment réalisés en préopératoire dans le but d’évaluer plus précisément ce risque. Le but de cette étude rétrospective était de déterminer pour chaque paramètre des EFR (exprimé en % de la valeur prédite) et des GDS, des valeurs permettant de définir les patients à haut risque de complications respiratoires postopératoires en construisant des courbes “Receiver Operating Characteristic” (ROC) et en calculant l’indice de Youden (sensibilité + spécificité −1). La valeur maximale de l’indice a été choisie comme valeur seuil. Cent quatre-vingt-quinze patients âgés de 65 ± 10 ans ont été étudiés rétrospectivement. La fréquence des complications respiratoires était à 15%, en moyenne, de 35% lorsque la capacité vitale (CV) était < à 77%, et de 12% (P = 0,002) pour une CV≥ à 77%, de 34% lorsque le volume expiré en 1 seconde (VEMS) était < à 76% contre 10% pour un VEMS ≥ à 76% (P = 0,0005), de 28% un débit expiratoire maximal à 75% de la CV(DEM75) < à 56% contre 10% chez les patients ayant un DEM75 ≥ à 56% Une hypoxémie ou une hypercapnie n’étaient pas prédictives d’une augmentation des complications respiratoires. La durée de séjour en réanimation et en postopératoire augmentait significativement chez les patients ayant une diminution de la CV ou du VEMS. La fréquence des complications respiratoires était de 9% chez les patients n’ayant aucune anomalie spirographique, de 16% chez ceux ayant une diminution isolée de la CV ou du VEMS et de 35% chez les patients ayant à la fois une diminution de VEMS et de la CV. Cependant, toutes les surfaces mesurées sous les courbes ROC étaient inférieures à 0,7. La réalisation préopératoire systématique des EFR et des GDS ne permet pas de prédire avec une sensibilité suffisante le risque de complication respiratoire postopératoire après chirurgie de l’aorte abdominale.
Abstract
The most frequent type of complication in patients undergoing aortic surgery is respiratory. Preoperative lung function (PFT) and arterial blood gas measurement (ABG) are often carried out to assess the risk more precisely. The aim of the present retrospective study was to determine which value of lung function test could identify patients who developed such complications. “Receiver Operating Characteristic” (ROC) curves and the area beneath the curve for the diagnosis of respiratory complications were calculated for each variable of PFT and ABG. The greatest Youden index for each variable was chosen as indicative pulmonary function criterion of increased risk of pulmonary complications. One hundred and ninety-five patients (age: 65 ± 10 years) were included. Respiratory complications occurred in 15% of patients. Respiratory complications increased from 12% if the vital capacity (VC) was ≥77% of the predicted value to 35% if the VC was <77% (P = 0,002), and from 10% if the FEV, was > 76% to 34% if the FEV, was ≥76% (P = 0,0005). A decreased PaO2 or increased PaCO2 was not correlated with an increased incidence of respiratory complications. Length of stay in ICU or in hospital were increased when VC or FEV1 were low. Frequency of pulmonary complications was 9% in patients without PFT abnormalities, 16% in patients with either diminished VC or FEV1 and 35% in patients with both lowered VC and FEV1. However, all the areas under the ROC curves were <0.7 and the sensitivity of the different variables was low. It is concluded that routine preoperative PFT and ABG cannot predict respiratory complications after abdominal aortic surgery.
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Ce travail a fait l’objet d’une communication au congrès de la Société Française d’Anesthésie Réanimation à Paris le 30 septembre 1994.
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Durand, M., Combes, P., Briot, R. et al. Prédiction des complications respiratoires après chirurgie de l’aorte abdominale. Can J Anaesth 42, 1101–1107 (1995). https://doi.org/10.1007/BF03015096
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DOI: https://doi.org/10.1007/BF03015096