In the current context, mechanical ventilation and ICU beds are limited but essential resources. Mechanical ventilation in the post-operative period adds to the morbidity and mortality of surgical patients and incurs extra stress on the patient, family and economic burden on the hospital. Hence, pre-operative prediction contributes to adequate optimisation and effective utilisation. But, unfortunately, the literature only provides us with predictors for mechanical ventilation in a very limited set of patients. Therefore, we experience a limitation in pre-operative optimisation, patient and family counselling and appropriate distribution of available resources.

Peri-operative inflammation is a state of high demand. Low albumin is a sign of poor nutritional status. Additionally, serum albumin being a negative acute phase reactant, the level is usually low in patients with heightened inflammation. CRP being a positive acute phase reactant, its level is usually raised in cases of any inflammation or any infections. So, the CRP/Albumin ratio gives us a combined health status of a patient. Further, CRP/Albumin ratio has been widely proven as a prognostic indicator and mortality predictor in patients with various malignancies and severe sepsis.

We, therefore hypothesise that patients with high pre-operative CRP/Albumin ratio will require mechanical ventilation post-operatively.