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Predictive value of the respiratory exchange ratio for the occurrence of postoperative complications in laparoscopic surgery: a prospective and observational study

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Abstract

Indirect measurement of the respiratory exchange ratio (RER) has been shown to predict the occurrence of postoperative complications after major open non-cardiac surgery. Our main objective was to demonstrate the ability of the RER, indirectly measured by the anaesthesia respirator, to predict the occurrence of postoperative complications following laparoscopic surgery. We performed an observational, prospective and monocentric study. Haemodynamic and respiratory parameters were collected at several timepoints to calculate the RER by a non-volumetric method: RER = (FetCO2–FiCO2)/(FiO2–FetO2). Fifty patients were prospectively included. Nine patients (18%) had at least one postoperative complication. The mean RER was significantly higher for the subgroup of patients with complications than the subgroup without (1.04 ± 0.27 vs 0.88 ± 0.13, p < 0.05). The RER could predict the occurrence of post-operative complications with an area under the ROC curve of 0.73 (95% CI 0.59–0.85, p = 0.021). The best cut off was 0.98, with a sensitivity of 56% and a specificity of 88%. One hour after insufflation, the FiO2–FetO2 difference was significantly lower and the RER was significantly higher in the complications subgroup than in the subgroup without complications (4.4/− 1.6% vs 5.8/− 1.2%, p = 0.001 and 0.95 [0.85–1.04] vs 0.83 [0.75–0.92], p = 0.04, respectively). The RER measured during laparoscopic surgery can predict the occurrence of postoperative complications.

Trial registration The objectives and procedures of the study was registered at Clinicaltrials.gov (NCT03751579); date: November 23, 2018.

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Abbreviations

ADH:

Antidiuretic hormone

AKI:

Acute kidney injury

ASA-PS:

American Society of Anesthesiologists physical status

BIS:

Bispectral index

CERAR:

Comité d’Éthique de la Recherche en Anesthésie-Réanimation

CI:

Cardiac index

CV:

Coefficient of variation

DavO2 :

Arterio-venous difference in oxygen

DO2 :

Oxygen delivery

GDT:

Goal-directed therapy

KDIGO:

Kidney disease improving global outcomes

FiCO2 :

Inspired fraction in CO2

FetCO2 :

End tidal fraction in CO2

FiO2 :

Inspired fraction in O2

FetO2 :

End tidal fraction in O2

HR:

Heart rate

LSC:

Least significant change

MAP:

Mean arterial pressure

PaO2/FiO2 :

Arterial oxygen partial pressure to fractional inspired oxygen ratio

PEEP:

Positive end-expiratory pressure

RER:

Respiratory exchange ratio

ROC:

Receiver operating characteristic

ScVO2 :

Central venous saturation in oxygen

STROBE:

Strengthening the reporting of observational studies in epidemiology

VCO2 :

CO2 production

VO2 :

O2 consumption

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Anaesthesiology and Critical Care Department, Amiens University Hospital, Rond-Point Fernand Leger, 80054, Amiens, France

    Stéphane Bar, Dimitri Santarelli, Bruno de Broca, Osama Abou Arab, Florent Leviel, Matthieu Miclo, Hervé Dupont & Emmanuel Lorne

  2. Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France

    Pierre-Grégroire Guinot

  3. Research Unit Simplification of Care for Complex Patients, UR 7518, University of Picardy Jules Verne, 80000, Amiens, France

    Stéphane Bar

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  1. Stéphane Bar
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  2. Dimitri Santarelli
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  3. Bruno de Broca
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  4. Osama Abou Arab
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  8. Pierre-Grégroire Guinot
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  9. Emmanuel Lorne
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Contributions

SB and PGG contributed to the study concept and design. SB, DS, BdB, OAA, MM, FL, HD, PGG, and EL contributed to the acquisition, analysis, or interpretation of the data. SB and PGG performed the statistical analysis. SB, PGG, HD, MM, and EL drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stéphane Bar.

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The authors have no financial conflicts of interest.

Statement of human rights

This research involving Human Participants was approved by an independent ethics committee (Comité d’Éthique de la Recherche en Anesthésie-Réanimation (CERAR); Ref: IRB 00010254-2018-156).

Informed consent

All patients provided their informed consent prior to inclusion in the study.

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Bar, S., Santarelli, D., de Broca, B. et al. Predictive value of the respiratory exchange ratio for the occurrence of postoperative complications in laparoscopic surgery: a prospective and observational study. J Clin Monit Comput 35, 849–858 (2021). https://doi.org/10.1007/s10877-020-00544-5

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  • DOI: https://doi.org/10.1007/s10877-020-00544-5

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