. 2018 Jul 3;13:29. doi: 10.1186/s13017-018-0189-y

Table 3.

PPC diagnostic criteria—Melbourne Group Score Version 3

When four or more of the following criteria^* are present anytime in the 24-h period 00:01 to 24:00 on a single postoperative day:
1. New abnormal breath sounds on auscultation different to preoperative assessment⁺
2. Production of yellow, green, or brown sputum different to pre-morbid status⁺
3. Pulse oximetry oxygen saturation (Sp0₂) < 90% on room air or FiO2 on 0.21 on more than one consecutive postoperative day^**
4. Raised maximum tympanic temperature ≥ 38 °C on more than one consecutive postoperative day
5. Chest radiograph report of collapse/consolidation^{# ***}
6. Presence of infective organisms on sputum culture report^***
7. White cell count > 11 or < 3
8. Physician’s diagnosis of postoperative pulmonary complication (e.g. atelectasis, pneumonia, AECOPD, respiratory failure, upper respiratory tract infection) OR prescription of an antibiotic specific for respiratory infection

Abbreviations: PPC postoperative pulmonary complications, SpO2 pulse oximetry, FiO2 fraction of inspired oxygen, AECOPD acute exacerbation of chronic obstructive pulmonary disease, PEEP positive end expiratory pressure, CXR chest X-ray

*If a blinded physiotherapist, nurse, or physician documents in the medical record the occurrence of a criterion, it can be taken as a positive finding. If no documentation present, a blinded assessor is required to assess this directly

⁺If no preoperative assessment or documentation assume normal at baseline

**For ventilated patients, if FiO₂ ≥ 0.5 or PEEP ≥ 8, assume criterion 3 is present (do not alter FiO₂), for all other patients set FiO₂ to 0.21 and observe SpO₂ for 2 min. If SpO₂ drops below 90%, immediately reinstate previous FiO₂. If not permissible to alter ventilation parameters, assume positive

^#If no written report for a CXR is available and a patient has three other positive signs, a masked senior physiotherapist or ward medical officer is to be contacted to report verbally on the available CXR

***When there are no daily measures of CXR or sputum sampling, carry over a positive finding to the next consecutive postoperative day