BACKGROUND The prospective observational European multicentre cohort study (POPULAR) of postoperative pulmonary complications (NCT01865513) did not demonstrate that adherence to the recommended train-of-four ratio (TOFR) of 0.9 before extubation was associated with better pulmonary outcomes from the first postoperative day up to hospital discharge. We re-analysed the POPULAR data as to whether there existed a better threshold for TOFR recovery before extubation to reduce postoperative pulmonary complications in patients who had quantitative neuromuscular monitoring (87% acceleromyography). METHODS To identify the optimal TOFR, the complete case cohort of patients with quantitative neuromuscular monitoring (n=3150) was split into several pairs of sub-cohorts related to TOFR values from 0.86 to 0.96; values of 0.97 and higher could not be used as the sub-cohorts were too small. The optimal TOFR was considered to have the lowest P-value from multivariate logistic regression calculated for each of the TOFR values. Data are presented as adjusted absolute risk reduction or median difference with 95% confidence interval. RESULTS Extubating patients with TOFR >0.95 rather than >0.9 reduced the adjusted risk of postoperative pulmonary complications by 3.5% (0.7-6.0%) from that reported in POPULAR (11.3%). Increasing the recommended TOFR from 0.9 to 0.95 reduced the adjusted risk by 4.9% (1.2-8.5%). Sub-cohorts resulting from 1:1 propensity score matching revealed that sugammadex had been given in higher doses by 0.30 (0.13-0.48) mg kg-1 in the sub-cohort with TOFR > 0.95. CONCLUSIONS A post hoc analysis of patients receiving quantitative monitoring of neuromuscular function suggests that postoperative pulmonary complications are reduced for TOFR > 0.95 before tracheal extubation compared with TOFR > 0.9. TRIAL REGISTRATION NUMBER NCT01865513.

中文翻译：

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气管拔管使用0.95比0.9的四列比率：流行数据的探索性分析。

背景术后肺部并发症的前瞻性观察性欧洲多中心队列研究（POPULAR）（NCT01865513）并未显示拔管前坚持推荐的四轮传动比（TOFR）0.9与术后第一天的肺预后更好相关直至出院。我们重新分析了流行数据，以了解拔管前是否存在更好的TOFR恢复阈值，以减少接受定量神经肌肉监测（87％加速肌电图）的患者的术后肺部并发症。方法为了确定最佳的TOFR，将具有定量神经肌肉监测功能的患者（n = 3150）的完整病例队列分为几对与TOFR值从0.86至0.96相关的亚队列。值为0。无法使用97及更高版本，因为子队列太小。根据针对每个TOFR值计算出的多元逻辑回归，最佳TOFR被认为具有最低的P值。数据以调整后的绝对风险降低或中位数差异（具有95％的置信区间）表示。结果拔除TOFR> 0.95而不是> 0.9的患者，其术后肺部并发症的调整后风险比流行病学报告的（11.3％）降低了3.5％（0.7-6.0％）。将建议的TOFR从0.9增加到0.95可将调整后的风险降低4.9％（1.2-8.5％）。由1：1倾向得分匹配产生的子队列显示，在TOFR> 0.95的子队列中，以0.30（0.13-0.48）mg kg-1的剂量给予了sugammadex较高的剂量。结论对接受神经肌肉功能定量监测的患者进行事后分析表明，与TOFR> 0.9相比，气管拔管前TOFR> 0.95可减少术后肺部并发症。试用注册号NCT01865513。