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Sun Y, Yao Y. Vasoactive-inotropic score/inotropic score and short-term outcomes in pediatrics undergoing cardiac surgery: A retrospective analysis from single center. J Card Surg 2022; 37:3654-3661. [PMID: 36069143 DOI: 10.1111/jocs.16914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY This study aimed to investigate the association between vasoactive-inotropic score/inotropic score (VIS/IS) and short-term outcomes in pediatric patients after cardiac surgery at a tertiary care center in an unselected pediatric population in China. METHODS This study carried out retrospective observation of 401 patients between April and June 2021 at a tertiary care center. VIS and IS were assessed intraoperatively (VIS-op, IS-op) and 2 h (VIS2h, IS2h), 24 h (VIS24h, IS24h), and 48 h (VIS48h, IS48h) postoperatively. The primary outcome was prolonged mechanical ventilation (PMV). Secondary outcomes included poor prognosis and length of stay in the pediatric intensive care unit and hospital. RESULTS Mean age of the included pediatric patients was 26.5 months. Pediatric cardiac procedures were performed within an average operation duration of 167.6 ± 70.8 min. Overall, the PMV group (n = 93) experienced significantly longer ACC duration, cardiopulmonary bypass duration, operation duration, and a higher prevalence of fluid accumulation overload than the non-PMV group (n = 93). Multivariate logistic regression analysis revealed that longer operation duration (odds ratio [OR]: 1.015; 95% confidence interval [95% CI]: 1.003, 1.026; p = .012) and higher VIS48h (OR: 1.188; 95% CI: 1.077, 1.311; p = .001) were strongest predictors for PMV. VIS48h had better discrimination power for PMV than other time intervals, and the area under the curve was 0.780 (95% CI, 0.721, 0.839; p = .000). CONCLUSIONS VIS48h independently predicted short-term outcomes after cardiac surgery in an unselected pediatric population in China and showed better prediction accuracy and discrimination capability than other time intervals.
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Affiliation(s)
- Yanting Sun
- Department of Anesthesiology, Baoji High-Tech Hospital, Baoji, Shaanxi, China.,Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuntai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth 2019; 122:428-436. [PMID: 30857599 DOI: 10.1016/j.bja.2018.12.019] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The vasoactive-inotropic score (VIS) predicts mortality and morbidity after paediatric cardiac surgery. Here we examined whether VIS also predicted outcome in adults after cardiac surgery, and compared predictive capability between VIS and three widely used scoring systems. METHODS This single-centre retrospective cohort study included 3213 cardiac surgery patients. Maximal VIS (VISmax) was calculated using the highest doses of vasoactive and inotropic medications administered during the first 24 h post-surgery. We established five VISmax categories: 0-5, >5-15, >15-30, >30-45, and >45 points. The predictive accuracy of VISmax was evaluated for a composite outcome, which included 30-day mortality, mediastinitis, stroke, acute kidney injury, and myocardial infarction. RESULTS VISmax showed good prediction accuracy for the composite outcome [area under the curve (AUC), 0.72; 95% confidence interval (CI), 0.69-0.75]. The incidence of the composite outcome was 9.6% overall and 43% in the highest VISmax group (>45). VISmax predicted 30-day mortality (AUC, 0.76; 95% CI, 0.69-0.83) and 1-yr mortality (AUC, 0.70; 95% CI, 0.65-0.74). Prediction accuracy for unfavourable outcome was significantly better with VISmax than with Acute Physiology and Chronic Health Evaluation II (P=0.01) and Simplified Acute Physiological Score II (P=0.048), but not with the Sequential Organ Failure Assessment score (P=0.32). CONCLUSIONS In adults after cardiac surgery, VISmax predicted a composite of unfavourable outcomes and predicted mortality up to 1 yr after surgery.
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Szylińska A, Listewnik M, Rotter I, Rył A, Kotfis K, Mokrzycki K, Kuligowska E, Walerowicz P, Brykczyński M. The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2572. [PMID: 30453599 PMCID: PMC6266912 DOI: 10.3390/ijerph15112572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/16/2022]
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Krzysztof Mokrzycki
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Ewelina Kuligowska
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
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Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium. J Crit Care 2017; 43:88-94. [PMID: 28854401 DOI: 10.1016/j.jcrc.2017.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/19/2017] [Accepted: 08/20/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. MATERIALS AND METHODS Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey. RESULTS 181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14<49 correlated with delirium (p=0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension. CONCLUSION Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.
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The definition of a prolonged intensive care unit stay for spontaneous intracerebral hemorrhage patients: an application with national health insurance research database. BIOMED RESEARCH INTERNATIONAL 2014; 2014:891725. [PMID: 25126579 PMCID: PMC4122095 DOI: 10.1155/2014/891725] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
Abstract
Introduction. Length of stay (LOS) in the intensive care unit (ICU) of spontaneous intracerebral hemorrhage (sICH) patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients' stay in ICUs and in hospitals will be shorter if integrated care systems are established.
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Debray TPA, Koffijberg H, Nieboer D, Vergouwe Y, Steyerberg EW, Moons KGM. Meta-analysis and aggregation of multiple published prediction models. Stat Med 2014; 33:2341-62. [PMID: 24752993 DOI: 10.1002/sim.6080] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 11/22/2013] [Accepted: 12/05/2013] [Indexed: 12/24/2022]
Abstract
Published clinical prediction models are often ignored during the development of novel prediction models despite similarities in populations and intended usage. The plethora of prediction models that arise from this practice may still perform poorly when applied in other populations. Incorporating prior evidence might improve the accuracy of prediction models and make them potentially better generalizable. Unfortunately, aggregation of prediction models is not straightforward, and methods to combine differently specified models are currently lacking. We propose two approaches for aggregating previously published prediction models when a validation dataset is available: model averaging and stacked regressions. These approaches yield user-friendly stand-alone models that are adjusted for the new validation data. Both approaches rely on weighting to account for model performance and between-study heterogeneity but adopt a different rationale (averaging versus combination) to combine the models. We illustrate their implementation in a clinical example and compare them with established methods for prediction modeling in a series of simulation studies. Results from the clinical datasets and simulation studies demonstrate that aggregation yields prediction models with better discrimination and calibration in a vast majority of scenarios, and results in equivalent performance (compared to developing a novel model from scratch) when validation datasets are relatively large. In conclusion, model aggregation is a promising strategy when several prediction models are available from the literature and a validation dataset is at hand. The aggregation methods do not require existing models to have similar predictors and can be applied when relatively few data are at hand.
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Affiliation(s)
- Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Ettema RGA, Hoogendoorn ME, Kalkman CJ, Schuurmans MJ. Development of a nursing intervention to prepare frail older patients for cardiac surgery (the PREDOCS programme), following phase one of the guidelines of the Medical Research Council. Eur J Cardiovasc Nurs 2013; 13:494-505. [DOI: 10.1177/1474515113511715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In older patients undergoing elective cardiac surgery, the timely identification and preparation of patients at risk for frequent postoperative hospital complications provide opportunities to reduce the risk of these complications. Aims: We developed an evidence-based, multi-component nursing intervention (Prevention of Decline in Older Cardiac Surgery Patients; the PREDOCS programme) for application in the preadmission period to improve patients’ physical and psychosocial condition to reduce their risk of postoperative complications. This paper describes in detail the process used to design and develop this multi-component intervention. Methods: In a team of researchers, experts, cardiac surgeons, registered cardiac surgery nurses, and patients, the revised guidelines for developing and evaluating complex interventions of the Medical Research Council (MRC) were followed, including identifying existing evidence, identifying and developing theory and modelling the process and outcomes. Additionally, the criteria for reporting the development of complex interventions in healthcare (CReDECI) were followed. Results: The intervention is administered during a consultation by the nurse two to four weeks before the surgery procedure. The consultation includes three parts: a general part for all patients, a second part in which patients with an increased risk are identified, and a third part in which selected patients are informed about how to prepare themselves for the hospital admission to reduce their risk. Conclusions: Following the MRC guidelines, an extended, stepwise, multi-method procedure was used to develop the multi-component nursing intervention to prepare older patients for cardiac surgery, creating transparency in the assumed working mechanisms. Additionally, a detailed description of the intervention is provided.
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Affiliation(s)
- Roelof GA Ettema
- University of Applied Science Utrecht, Faculty of Health Care, The Netherlands
- University Medical Centre Utrecht, The Netherlands
| | | | | | - Marieke J Schuurmans
- University of Applied Science Utrecht, Faculty of Health Care, The Netherlands
- University Medical Centre Utrecht, The Netherlands
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Ettema RGA, Van Koeven H, Peelen LM, Kalkman CJ, Schuurmans MJ. Preadmission interventions to prevent postoperative complications in older cardiac surgery patients: a systematic review. Int J Nurs Stud 2013; 51:251-60. [PMID: 23796313 DOI: 10.1016/j.ijnurstu.2013.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE(S) The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications. METHODS We systematically reviewed the literature following the PRISMA statement guidelines. RESULTS Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population. CONCLUSIONS Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients.
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Affiliation(s)
- Roelof G A Ettema
- Nursing and Paramedical Care for People With Chronic Illnesses, University of Applied Science Utrecht, Faculty of Health Care, Bolognalaan 101, 3584 CJ Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Heleen Van Koeven
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Linda M Peelen
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Cor J Kalkman
- Professor of Anesthesiology, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Nursing and Paramedical Care for People With Chronic Illnesses, University of Applied Science Utrecht, Faculty of Health Care, Bolognalaan 101, 3584 CJ Utrecht, The Netherlands; Professor of Nursing Science, Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med 2012; 38:192-209. [PMID: 22215044 PMCID: PMC3291847 DOI: 10.1007/s00134-011-2447-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 12/29/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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