Table 1.
Grading of postoperative cardiopulmonary complications
| Diagnostic criteria | Grade I | Grade II | Grade III | Grade IV | |
|---|---|---|---|---|---|
| Cardiac | |||||
| – Arrythmia | ECG, treatment with electrolytes, drugs and/or electrical shock | SVE, benign VE, sinus tachycardia, AF + electrolytes adjustment | + pharmacological treatment (anti-arrhythmic) | tachyarrhythmia + electrical shock | cardiac arrest + defibrillation and/or resuscitative maneuvers |
| – Conduction blockade | ECG, treatment with pacemaker | AV 1st–2nd degree block | AV 2nd degree block (Wenckeback) | AV 3rd degree block + pacemaker | |
| – Cardiac insufficiency | Chest X-rays, drugs, echocardiography, ICU/HDU transfer, assist device | asymptomatic | + diuretics, vasodilators | + transfer in HDU or ICU,inotropes | low cardiac output syndrome, aortic balloon counterpulsation |
| – Tamponnade | echocardiography, drainage | pericardial drainage | low cardiac output and drainage | ||
| – Myocardial ischemia/infarct | ECG, troponin | Transient ECG changes: ST-segment, T wave | Troponin 0.1–1.5 ng/ml | Troponin > 1.5 ng | Troponin > 1.5 ng, unstable angina, arrhythmias, low cardiac output |
| Pulmonary | |||||
| – Atelectasis | Chest-X rays, CT-scan, treatment | + chest physiotherapy | + CPAP | + bronchial fibroscopy | |
| – Bronchopneumonia | Temperature, WBC count,bacteriology, treatment | + antibiotics, on the ward | + antibiotics and supportive respiratory treatment | + respiratory failure | |
| – Hypoxemia | SpO2, PaO2, A-aDO2, PaO2/FIO2, chest X-rays treatment | + oxygen therapy | + oxygen therapy | PaO2/FIO2 < 220 + NIV ALI/ARDS | PaO2/FIO2 < 220 + intubation, mechanical ventila tion, ALI/ARDS |
| – Respiratory failure | Need for ventilatory support | + NIV | intubation, mechanical ventilation | ||
| – Bronchopleural fistula | bronchoscopy, treatment | + endoscopic treatment | + surgical closure, empyema | ||
| – Pleural effusion | chest X-rays, drainage | mild | + thoracic drainage | ||
Abbreviations: SVE, supraventricular extrasystole; VE, ventricular extrasystole; AF, atrial fibrillation; AV, atrioventricular; HDU, high dependency unit; ICU, intensive care unit; ALI, acute lung injury; ARDS, adult respiratory distress syndrome.
Adapted from Dindo D, Clavien PA. 2004.