Driving Pressure and Postoperative Pulmonary Complications in Thoracic Surgery

Postoperative pulmonary complications are defined as one or more of the following:

• Hypoxia: SpO2 < 90%
• Requiring oxygen therapy: Facial mask, nasal prong, continuous positive airway pressure, non-invasive positive pressure breathing or high flow nasal oxygen supply between POD 2 and 7.
• Initial ventilator supports longer than 24 h
• Re-intubation
• Requiring mechanical ventilation
• Tracheostomy
• Pneumonia
• Empyema
• Atelectasis requiring bronchoscopy
• Acute respiratory distress syndrome
• Acute lung injury
• Persistent emphysema or pneumothorax or air leak requiring chest tube for 5 days or more
• Prolonged pleural effusion requiring chest tube for 5 days or more
• Bronchopleural fistula
• Contralateral pneumothorax
• Pulmonary embolism embolism

Partial pressure of oxygen in arterial blood (PaO2, mmHg) or PaO2/Inspired oxygen fraction (PF ratio)

the need for rescue ventilation to treat hypoxia (Inspired oxygen fraction 1.0, two lung ventilation, recruitment, PEEP change, Tidal volume change, continuous positive pressure ventilation, change to pressure control mode)

Lung compliance (mL/mmHg)

C-reactive protein (mg/L) of laboratory exam

red blood cell, fresh frozen plasma, platelet

acute kidney injury(acute kidney injury network criteria): Stage I: Diuresis < 0.5 mg/kg (6 h) or increase in serum Cr > 0.3 mg/dl. Stage II: Diuresis < 0.5 mg/kg (12 h) or basal Cr x 2 mg/dL. Stage III: Diuresis < 0.3 mg/kg (24 h) or anuria (12 h) or basal Cr x 3 mg/dL, or Cr > 4 mg/dL or renal replacement therapy.

diagnosed by Confusion Assessment method (CAM: positive or negative) or Medicines for treating delirium symptoms include antipsychotic drugs and benzodiazepines

: The CDC defines a superficial incisional surgical site infection as one which meets the following criteria.

• Infection occurs within 30 days after surgery and
• Involves only skin and subcutaneous tissue of the incision and
• The patient has at least one of the following:

• purulent drainage from the superficial incision
• organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision
• at least one of the following symptoms or signs of infection: pain or tenderness, localised swelling, redness or heat, and superficial incision is deliberately opened by surgeon and is culture positive or not cultured. A culture negative finding does not meet this criterion.
• diagnosis of an incisional surgical site infection by a surgeon or attending physician.

Acute myocardial injury with clinical evidence of acute myocardial ischemia and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th percentile upper reference limit and at least one of the following:

• Symptoms of myocardial ischemia
• New ischemic ECG changes
• Development of pathological Q waves
• Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
• Identification of a coronary thrombus by angiography or autopsy (not for types 2 or 3 myocardial infarctions)

Percutaneous coronary intervention or coronary artery surgery

Magnetic resonance imaging diagnosis

: A subset of sepsis (a life-threatening organ dysfunction resulting from dysregulated host responses to infection) in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase the risk of mortality. Despite adequate fluid resuscitation, patients have hypotension requiring vasopressors to maintain a mean arterial blood pressure above 65 mmHg and have an elevated serum lactate concentration of more than 2 mmol/L

New arrhythmias that persist for more than 2 days

the duration of hospital stay and intensive care unit stay (day)

re-admission because of surgical related problems

in hospital death or out of hospital