[A respiratory failure rating scale in neurosurgical patients]

Abstract

A respiratory failure (RF) rating scale has been developed to objectify indications for artificial ventilation (AV). The scale consists of three blocks gauging the level of consciousness, the degree of swallowing problems, cough, airway patency, and lung parenchymatous injury. The scale was tested in the period December 2009 to March 2010. Selection of patients in accordance with the chosen study inclusion and exclusion criteria allowed 15 patients to be enrolled in the study. Of them there were 8 (53%) women and 7 (47%) men. The patients' age was 25 to 68 years; median age was 42 years. There were cerebrovascular aneurysms and brain tumors of various locations and histology in 7 and 8 cases, respectively. Three groups of patients were identified. The first two groups included patients with successful extubation, but Group 2 patients were further reintubated because of neurological deterioration. In Group 3 patients, extubation was unsuccessful, i.e. these required reintubation within 48 hours after extubation. Groups 2 and 3 patients developed inflammatory complications, such as nosocomial pneumonia and sepsis; there were worse outcomes. If the tactics of AV initiation were determined from scale scores, it should not differ in Groups 1 and 2. Based on the scale scores, AV should be regained much more early than was practised. The developed scale allows one to optimize the time of AV initiation. Single patient assessment can ascertain a direct cause of respiratory failure (RF) while dynamic assessment can determine the sequence of changes in the magnitude of individual determinants of RF. In patients with unsuccessful tracheal intubation, the scale will optimize the time of reintubation, thereby reducing the incidence of nosocomial and aspiration pneumonia.