6533b835fe1ef96bd129ff37
RESEARCH PRODUCT
Morbidity and mortality after anaesthesia in early life:results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)
Nicola DismaFrancis VeyckemansKatalin ViragTom G. HansenKarin BeckePierre HarletLaszlo VutskitsSuellen M. WalkerJurgen C. De GraaffMarzena ZielinskaDusica SimicThomas EngelhardtWalid HabreChristian BreschanRudolf LikarManuela PlatzerIsole EdelmanJohanes EgerStefan HeschlBrigitte MessererMaria VittinghofRuth KroessMartina StichlbergerDavid KahnThierry PirotteCaroline PregardienFrancis VeyckemansFrance StevensJohan BerghmansAnnemie BautersLuc De BaerdemaekerStefan De HertKoen LapageAliaksandra ParashchankaJurgen Van LimmenPiet WyffelsJulie LauwerynsNadia NajafiJoris VundelinckxDiana ButkovićIvana Kerovec SorićSandra KralikAna MarkićJosip AzmanJosko MarkicDaniela PupacicMichal FrelichPetr ReimerRene UrbanecPetra CajkovaVladimir MixaYvona SedlačkovaLenka KnoppovaAlena Zlamalova (Nee Květoňova)Martin VavřinaJiři ŽUrekTom HansenArash AfshariAnders B. BilleMarguerite EllekvistMari-liis IlmojaReet MoorReet KikasMerle ValiKariantti KallioElisa ReponenPertti SuominenSami SuvantoRaisa VahataloHannu KokkiMerja KokkiJarkko HarjuMiia KokkonenJenni VieriTuula MannerCatherine AmoryHugues LudotDina BertJuliette GodartAnne LaffargueHerve DupontBenjamin UrbinaCatherine BaujardPhilippe RoulleauGiuseppe StaitiMaryline BordesKarine Nouette GaulainYann HamonicFrancois SemjenOlivier JacqmarcqCaroline Lejus-bourdeauCecile MagneLea PetryLilica RosAurelien ZangMehdi BennisBernard CoustetsRose FesseauIsabelle ConstantEliane KhalilNada SabourdinNoemie AudrenThomas DescarpentriesFanny FabreAurelien LegrandEmilie DruotGilles OrliaguetLucie SabauLynn UhrigFrancois De La BriereKarin JonckheerJean-paul MissionLucia ScordoCaroline CouchepinChristophe DadurePablo De La ArenaLaurent HertzPhilippe PiratChrystelle SolaMyriam BellonSouhayl DahmaniFlorence Julien-marsollierDaphne MicheletVeronique Depret-donatienAnne LesageJost KaufmannMichael LaschatFrank WapplerKarin BeckeLena BrunnerKarin OppenriederGregor BadeltKarin HochmuthBernhard KollerAnita ReilSebastian RichterThomas FischerAnja DiersClemens SchorerAndreas WeylandRuth CohauszFranz-josef KretzMichaela LofflerMarkus WilbsClaudia HoehneJohanna UlriciChristiane GoetersArmin FlinspachMatthias KlagesSimone LindauLeila MessroghliKai ZacharowskiChristoph EisnerThomas MuellerDaniel RichterMelanie SchaferMarkus WeigandSebastian WeitererMiriam OchsenreiterMichael ScholerTom TerbovenIsabel EggemannSascha HaussmannNicolas LeisterChristoph MenzelUwe TrieschmannSirin YucetepeSusanna KeiligPeter KrankeYvonne JeltingTorsten BaehnerRichard EllerkmannShahab GhamariClaudia NeumannMartin SohlePelagia ChloropoulouVagia NtritsouPinelopi PapagiannopoulouEleana GariniAfroditi KarafotiaPanagoula MammiEvangelia BaliDespoina IordanidouAnna MalisiovaArtemis PolyzoiAdelais TsiotouErzsebet SapiEdgar SzekelyNandor KosikVeronika MaracziJanos SchnurJudit CsillagJanos GalGergely GoblBalazs HauserAndras PetroczyGyula TovishaziStuart BlainSarah GallagherSinead HarteMandy JacksonEmma MeehanZeenat NawoorBrendan O’hareMark RossDaniela LerroMarinella AstutoChiara GrassoRita ScalisiGiulia FrasaccoElena LenaresRoberto LeoneMaurizia GrazziniCarmelo MinardiNicola ZadraGilda CinnellaAntonella CotoiaDario GalanteBrita De LorenzoBeate KuppersGiulia BottazziFabio CaramelliMaria C. MondardiniEmanuele RossettiSergio PicardoAlessandro VittoriAnna CamporesiAndrea WolflerEdoardo CalderiniLaura B. ColantonioSimona A. FinamoreGiuliana A. PorroRachele BonfiglioNicola DismaSvetlana KotzevaLeila MameliGirolamo MattioliCamilla MicalizziAlessia MontagutiAngela PistorioClelia ZanaboniAnna GuddoGerald R. NebaMoreno FavaratoBruno G. LocatelliMicol MaffiolettiValter SonzogniRossella GarraMaria SammartinoFabio SbaragliaAndrea CortegianiAlessandra MoscarelliElena AttanasiSimonetta TesoroCristina AgapitiFrancesca PinzoniCesare VezzoliFederico BilottaArta BarzdinaZane StraumeAnda ZundaneLaura LukosieneIrena MaraulaiteIlona RazleviceBernd SchmitzStephanie MifsudCarolin AehlingCelia AllisonRients De BoerDina EmalMarkus StevensMarielle BuitenhuisJurgen De GraaffInge De LiefdeAndreas MachottaGail ScoonesLonneke StaalsJeremy TomasAnouk Van DerKnijff-van DortmontMarianne VeldhuizenDavid AldersWolfgang BuhreEva SchafratJan SchreiberPetronella M. VermeulenMark HendriksSandra LakoMarieke Voet-lindnerBarbe PietersGert-jan SchefferLuc TielensAnthony AbsalomMargot BergsmaJoke De RuiterSascha MeierMartin VolkersTjerk ZweersAnne M. BeukersChrista BoerJurgen DertingerSandra NumanBas Van ZaaneWenche B. BoerkeNil EkizKristoffer StensrudInger M. DrageErik R. IsernAlicja Bartkowska-sniatkowskaMalgorzata GrzeskowiakMagdalena Juzwa-sobierajJowita Rosada-kurasińskaArtur BaranowskiKarina JakubowskaDorota LewandowskaMagdalena Mierzewska-schmidtPiotr SawickiMagdalena Urban-lechowiczPomianek PrzemyslawMarzena ZielinskaTeresa LealMaria SoaresPedro PinaSilvia PinhoMaria Domingas PatuleiaCatarina C. EstevesHelena SalgadoMaria J. SantosRodica BadetiIulia CindeaLoredana OanaAdriana GuritaLuminita IlieGabriel MocioiuRadu TabacaruIrina TranteValentin MunteanuMihai MorariuEmese NyiriIvana BudicVesna MarjanovicBiljana DraškovićMarina PandurovJordanka IlicAna MandrasZdenka RadosNikola StankovicMaja SuicaSladjana VasiljevicMirjana KnezevicIrina MilojevicIvana PetrovSelena Puric RacicDusica SimicIrena SimicMarija StevicIrena VulicevicBarbora CabanovaMiloslav HanulaJelena BergerDarja JanjatovicŠPela P. ŠTupnikIvan KohnUlf LindestamJarl ReinhardAlbert CastellheimKerstin SandstromSporre BengtRainer DorenbergPeter FrykholmMaria GarciaAnn KvarnstromEmma PontenThomas BruelisauerGabor ErdoesHeiko KaiserMathias MarchonThomas RivaStefan SeilerYann BoegliMirko DolciCarine MarcucciWalid HabreIsabelle PichonLaszlo VutskitsMattias CasuttMartin HolzleThomas HurniMartin JohrNull Anna-ursinaNull MalarJacqueline MauchThomas ErbKarin OeinckMine AkinGulsen KeskinYesim SenayliGuner KayaPinar KendigelenAyse C. TutuncuZehra HatipoğluDilek OzcengizHale Aksu ErdostElvan OcmenCimen OlgunerHilmi AyanogluPelin C. DincerTumay UmurogluMustafa AzizogluHandan BirbicerNurcan DorukAslı SagunSibel BarisDmytro DmytriievSridevi KuchiNuria MasipPeter BrooksAlison HareNargis AhmadMichelle CaseySam De SilvaNadine DobbyPrakash KrishnanL. Amaki SogbodjorEllie WalkerSuellen WalkerStephanie KingKaty NicholsonMichelle QuinneyPaul StevensAndrew BlevinMariangela GiombiniChulananda GoonasekeraSadia AdilStephanie BewCarol BodlaniDan GilpinStephanie JinksNalini MalarkkanAlice MiskovicRebecca PadJuliet W. BarryJoy AbbottJames ArmstrongNatalie CooperLindsay CrateJohn EmeryKathryn JamesHannah KingPaul MartinStefano S. CatenacciRob BomontPaul SmithSara MeleAlessandra VerzelloniPhilippa DixGraham BellElena GordevaLesley MckeeEsther NganJutta ScheffczikLi-en TanMark WorrallCarmel CassarKevin GoddardVictoria BarlowVimmi OshanKhairi ShahSarah BellLisa DanielsMonica GandhiDavid PachterChris PerryAndrew RobertsonCarmen ScottLynne WaringDavid BarnesSophie ChildsJoanne NormanRobin Sunderlandsubject
MaleTime FactorsHealth StatusComorbidityIntraoperative Complications/diagnosis/epidemiology/mortality/therapy0302 clinical medicinePostoperative Complications030202 anesthesiologyRisk Factorspatient safetyMedicineAnesthesiaProspective StudiesProspective cohort studyIntraoperative ComplicationsMedical Auditddc:617Incidence (epidemiology)IncidenceAge FactorsGestational agecritical eventsEuropeAnesthetics/adverse effectsqualityAnesthesiaSurgical Procedures OperativeoutcomeFemaleInfant PrematureGestational AgeAnesthesia/adverse effects/mortalityRisk AssessmentEurope/epidemiology03 medical and health sciencesHumansAnestheticsquality.business.industryPostoperative Complications/diagnosis/epidemiology/mortality/therapyPostmenstrual AgeInfant NewbornInfantmedicine.disease3126 Surgery anesthesiology intensive care radiologyComorbidityneonatesClinical trialSurgical Procedures Operative/adverse effects/mortalityAnesthesiology and Pain MedicineBlood pressureObservational studycritical eventneonatebusinessdescription
Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348. © 2021 The Authors Association of Anaesthetists of Great Britain and Ireland European Society of Anaesthesiology and Intensive Care - Clinical Trial Network (ESAIC-CTN); Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) funded the study for the follow-up of patients enrolled in the UK.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-06-01 |