• Curtis C Copeland, Andrew Young, Tristan Grogan, Eilon Gabel, Anahat Dhillon, and Vadim Gudzenko.
• U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, United States; University of Maryland School of Medicine, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, US Air Force C-STARS Baltimore, 22 S. Greene Street, T4M14, Baltimore, MD 21201, United States; David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States. Electronic address: curtiscopeland@gmail.com.
• J Clin Anesth. 2017 Jun 1; 39: 122-127.

Study ObjectiveRisk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure.DesignRetrospective cohort analysis over a 21-month period.SettingFive adult intensive care units (ICUs) at a single tertiary medical center.PatientsThree hundred fifty ICU patients in respiratory failure, who underwent 501 procedures with general anesthesia.MeasurementsDemographic, clinical, and surgical variables were collected from the pre-anesthesia evaluation forms and preoperative ICU charts. The primary outcome was survival to discharge.Main ResultsNinety-six patients (27%) did not survive to discharge. There were significant differences between survivors and non-survivors for ASA (3.7 vs. 3.9, p=0.001), RCRI (1.6 vs. 2.0, p=0.003), and SOFA score (8.1 vs. 11.2, p<0.001). Based on the area under the receiver operating characteristic curve for these relationships, there was only modest discrimination between the groups, ranging from the most useful SOFA (0.68) to less useful RCRI (0.60) and ASA (0.59).ConclusionsThis single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.Published by Elsevier Inc.

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