1
|
Sun YT, Wu W, Yao YT. The association of vasoactive-inotropic score and surgical patients' outcomes: a systematic review and meta-analysis. Syst Rev 2024; 13:20. [PMID: 38184601 PMCID: PMC10770946 DOI: 10.1186/s13643-023-02403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The objective of this study is to conduct a systematic review and meta-analysis examining the relationship between the vasoactive-inotropic score (VIS) and patient outcomes in surgical settings. METHODS Two independent reviewers searched PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, Google Scholar, and CNKI databases from November 2010, when the VIS was first published, to December 2022. Additional studies were identified through hand-searching the reference lists of included studies. Eligible studies were those published in English that evaluated the association between the VIS and short- or long-term patient outcomes in both pediatric and adult surgical patients. Meta-analysis was performed using RevMan Manager version 5.3, and quality assessment followed the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. RESULTS A total of 58 studies comprising 29,920 patients were included in the systematic review, 34 of which were eligible for meta-analysis. Early postoperative VIS was found to be associated with prolonged mechanical ventilation (OR 5.20, 95% CI 3.78-7.16), mortality (OR 1.08, 95% CI 1.05-1.12), acute kidney injury (AKI) (OR 1.26, 95% CI 1.13-1.41), poor outcomes (OR 1.02, 95% CI 1.01-1.04), and length of stay (LOS) in the ICU (OR 3.50, 95% CI 2.25-5.44). The optimal cutoff value for the VIS as an outcome predictor varied between studies, ranging from 10 to 30. CONCLUSION Elevated early postoperative VIS is associated with various adverse outcomes, including acute kidney injury (AKI), mechanical ventilation duration, mortality, poor outcomes, and length of stay (LOS) in the ICU. Monitoring the VIS upon return to the Intensive Care Unit (ICU) could assist medical teams in risk stratification, targeted interventions, and parent counseling. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359100.
Collapse
Affiliation(s)
- Yan-Ting Sun
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Wei Wu
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China.
| |
Collapse
|
2
|
Pölkki A, Pekkarinen PT, Lahtinen P, Koponen T, Reinikainen M. Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care. Acta Anaesthesiol Scand 2023; 67:1219-1228. [PMID: 37278095 DOI: 10.1111/aas.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The cardiovascular component of the sequential organ failure assessment (cvSOFA) score may be outdated because of changes in intensive care. Vasoactive Inotropic Score (VIS) represents the weighted sum of vasoactive and inotropic drugs. We investigated the association of VIS with mortality in the general intensive care unit (ICU) population and studied whether replacing cvSOFA with a VIS-based score improves the accuracy of the SOFA score as a predictor of mortality. METHODS We studied the association of VIS during the first 24 h after ICU admission with 30-day mortality in a retrospective study on adult medical and non-cardiac emergency surgical patients admitted to Kuopio University Hospital ICU, Finland, in 2013-2019. We determined the area under the receiver operating characteristic curve (AUROC) for the original SOFA and for SOFAVISmax , where cvSOFA was replaced with maximum VIS (VISmax ) categories. RESULTS Of 8079 patients, 1107 (13%) died within 30 days. Mortality increased with increasing VISmax . AUROC was 0.813 (95% confidence interval [CI], 0.800-0.825) for original SOFA and 0.822 (95% CI: 0.810-0.834) for SOFAVISmax , p < .001. CONCLUSION Mortality increased consistently with increasing VISmax . Replacing cvSOFA with VISmax improved the predictive accuracy of the SOFA score.
Collapse
Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pasi Lahtinen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koponen
- Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Joensuu, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
3
|
See Hoe LE, Li Bassi G, Wildi K, Passmore MR, Bouquet M, Sato K, Heinsar S, Ainola C, Bartnikowski N, Wilson ES, Hyslop K, Skeggs K, Obonyo NG, Shuker T, Bradbury L, Palmieri C, Engkilde-Pedersen S, McDonald C, Colombo SM, Wells MA, Reid JD, O'Neill H, Livingstone S, Abbate G, Haymet A, Jung JS, Sato N, James L, He T, White N, Redd MA, Millar JE, Malfertheiner MV, Molenaar P, Platts D, Chan J, Suen JY, McGiffin DC, Fraser JF. Donor heart ischemic time can be extended beyond 9 hours using hypothermic machine perfusion in sheep. J Heart Lung Transplant 2023; 42:1015-1029. [PMID: 37031869 DOI: 10.1016/j.healun.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND The global shortage of donor hearts available for transplantation is a major problem for the treatment of end-stage heart failure. The ischemic time for donor hearts using traditional preservation by standard static cold storage (SCS) is limited to approximately 4 hours, beyond which the risk for primary graft dysfunction (PGD) significantly increases. Hypothermic machine perfusion (HMP) of donor hearts has been proposed to safely extend ischemic time without increasing the risk of PGD. METHODS Using our sheep model of 24 hours brain death (BD) followed by orthotopic heart transplantation (HTx), we examined post-transplant outcomes in recipients following donor heart preservation by HMP for 8 hours, compared to donor heart preservation for 2 hours by either SCS or HMP. RESULTS Following HTx, all HMP recipients (both 2 hours and 8 hours groups) survived to the end of the study (6 hours after transplantation and successful weaning from cardiopulmonary bypass), required less vasoactive support for hemodynamic stability, and exhibited superior metabolic, fluid status and inflammatory profiles compared to SCS recipients. Contractile function and cardiac damage (troponin I release and histological assessment) was comparable between groups. CONCLUSIONS Overall, compared to current clinical SCS, recipient outcomes following transplantation are not adversely impacted by extending HMP to 8 hours. These results have important implications for clinical transplantation where longer ischemic times may be required (e.g., complex surgical cases, transport across long distances). Additionally, HMP may allow safe preservation of "marginal" donor hearts that are more susceptible to myocardial injury and facilitate increased utilization of these hearts for transplantation.
Collapse
Affiliation(s)
- Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia.
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Uniting Care Hospitals, Intensive Care Units St Andrew's War Memorial Hospital and The Wesley Hospital, Brisbane, Queensland, Australia; Wesley Medical Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Queensland, Australia
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kris Skeggs
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom; Initiative to Develop African Research Leaders (IDeAL), Kilifi, Kenya
| | - Tristan Shuker
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lucy Bradbury
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chiara Palmieri
- School of Veterinary Science, Faculty of Science, University of Queensland, Gatton, Queensland, Australia
| | | | - Charles McDonald
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Anesthesia and Perfusion, The Prince Charles Hospital, Queensland, Australia
| | - Sebastiano M Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matthew A Wells
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Janice D Reid
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Hollier O'Neill
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Haymet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lynnette James
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ting He
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Meredith A Redd
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Institute for Molecular Bioscience, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Maximillian V Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Molenaar
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan Chan
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David C McGiffin
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Ning YL, Sun C, Xu XH, Li L, Ke YJ, Mai Y, Lin XF, Yang ZQ, Xian SX, Chen WT. Tendency of dynamic vasoactive and inotropic medications data as a robust predictor of mortality in patients with septic shock: An analysis of the MIMIC-IV database. Front Cardiovasc Med 2023; 10:1126888. [PMID: 37082452 PMCID: PMC10112491 DOI: 10.3389/fcvm.2023.1126888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
BackgroundSeptic shock patients fundamentally require delicate vasoactive and inotropic agent administration, which could be quantitatively and objectively evaluated by the vasoactive–inotropic score (VIS); however, whether the dynamic trends of high-time-resolution VIS alter the clinical outcomes remains unclear. Thus, this study proposes the term VIS Reduction Rate (VRR) to generalise the tendency of dynamic VIS, to explore the association of VRR and mortality for patients with septic shock.MethodsWe applied dynamic and static VIS data to predict ICU mortality by two models: the long short-term memory (LSTM) deep learning model, and the extreme gradient boosting (XGBoost), respectively. The specific target cohort was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database by the sophisticated structured query language (SQL). Enrolled patients were divided into four groups by VRR value: ≥50%, 0 ~ 50%, −50% ~ 0, and < −50%. Statistical approaches included pairwise propensity score matching (PSM), Cox proportional hazards regression, and two doubly robust estimation models to ensure the robustness of the results. The primary and secondary outcomes were ICU mortality and in-hospital mortality, respectively.ResultsVRR simplifies the dosing trends of vasoactive and inotropic agents represented by dynamic VIS data while requiring fewer data. In total, 8,887 septic shock patients were included. Compared with the VRR ≥50% group, the 0 ~ 50%, −50% ~ 0, and < −50% groups had significantly higher ICU mortality [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.17–1.50, p < 0.001; HR 1.79, 95% CI 1.44–2.22, p < 0.001; HR 2.07, 95% CI 1.61–2.66, p < 0.001, respectively] and in-hospital mortality [HR 1.43, 95% CI 1.28–1.60, p < 0.001; HR 1.75, 95% CI 1.45–2.11, p < 0.001; HR 2.00, 95% CI 1.61–2.49, p < 0.001, respectively]. Similar findings were observed in two doubly robust estimation models.ConclusionThe trends of dynamic VIS in ICU might help intensivists to stratify the prognosis of adult patients with septic shock. A lower decline of VIS was remarkably associated with higher ICU and in-hospital mortality among septic shock patients receiving vasoactive–inotropic therapy for more than 24 h.
Collapse
Affiliation(s)
- Yi-Le Ning
- Department of Pulmonary and Critical Care Medicine (PCCM), Bao’an District Hospital of Chinese Medicine, Shenzhen, China
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ce Sun
- Department of Critical Care Medicine, Meizhou Hospital of Chinese Medicine, Meizhou, China
| | - Xiang-Hui Xu
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Bao’an District Hospital of Chinese Medicine, Shenzhen, China
| | - Li Li
- Department of Pulmonary and Critical Care Medicine (PCCM), The First People’s Hospital of Kashgar Prefecture, Kashgar, China
| | - Yan-Ji Ke
- Department of Critical Care Medicine, The Fourth People’s Hospital of Foshan, Foshan, China
| | - Ye Mai
- Department of Critical Care Medicine, Chinese Medicine Hospital of Hainan Province, Haikou, China
| | - Xin-Feng Lin
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Xin-Feng Lin,
| | - Zhong-Qi Yang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Zhong-Qi Yang,
| | - Shao-Xiang Xian
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Shao-Xiang Xian,
| | - Wei-Tao Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Wei-Tao Chen,
| |
Collapse
|
5
|
Keizman E, Abarbanel I, Salem Y, Mishaly D, Serraf AE, Pollak U. The Impact of Dominant Ventricular Morphology on the Early Postoperative Course After the Glenn Procedure. Pediatr Cardiol 2023; 44:1076-1082. [PMID: 36781464 DOI: 10.1007/s00246-023-03114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
The dominant ventricular morphology affects both the early and late outcomes of the Fontan procedure, but its impact on the patients' status immediately following the Glenn procedure is unknown. This study aims to evaluate the effect of the infants' dominant ventricular morphology on the immediate course after undergoing the Glenn procedure. This single-center, retrospective study included all patients who underwent the Glenn procedure between October 2003 and May 2016. The patients were divided into two groups according to their dominant ventricular morphology. Their postoperative records were reviewed and compared. Out of the 89 patients who underwent the Glenn procedure during the study period, 40 (44.9%) had dominant right ventricular morphology and 49 (55.1%) had left ventricular morphology. There were no significant group differences in baseline characteristics or operative data. The maximal postoperative vasoactive-inotropic score was significantly higher and the extent of ventricular dysfunction was significantly more severe in the dominant right ventricle group (P < 0.05). The length of hospitalization was slightly but not significantly longer in the hypoplastic LV group. It is concluded that patients with a dominant LV morphology had a superior ventricular function and required less inotropic support compared to that of a dominant RV morphology in the immediate postoperative course following the Glenn procedure. Survival was not affected by these differences. Further study to determine the pathophysiologic basis for these differences is warranted.
Collapse
Affiliation(s)
- Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel.
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Inbar Abarbanel
- Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Yishai Salem
- Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alain E Serraf
- Pediatric and Congenital Heart Center, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel
- The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Uri Pollak
- The Hebrew University Hadassah Medical School, Jerusalem, Israel
- Section of Pediatric Critical Care, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel
| |
Collapse
|
6
|
Soni R, Soni N, Chakkarapani A, Gupta S, Yajamanyam PK, Ali SKM, El Anbari M, Alhamad M, Anand D, More K. The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality. Pediatr Cardiol 2023; 44:354-366. [PMID: 36163300 PMCID: PMC9895036 DOI: 10.1007/s00246-022-03002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/29/2022] [Indexed: 02/06/2023]
Abstract
Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36-39) and birth weight of 2.83 kg (IQR 2.45-3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality.
Collapse
Affiliation(s)
- Roopali Soni
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Neonatal Unit, Mediclinic Parkview Hospital, Dubai, UAE
| | - Naharmal Soni
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Aravanan Chakkarapani
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Samir Gupta
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Phani Kiran Yajamanyam
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Sanoj K. M. Ali
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Mohammed El Anbari
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Moath Alhamad
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Dhullipala Anand
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Kiran More
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar.
| |
Collapse
|
7
|
Demirhan S, Topcuoglu S, Karadag N, Ozalkaya E, Karatekin G. Vasoactive inotropic score as a predictor of mortality in neonatal septic shock. J Trop Pediatr 2022; 68:6833201. [PMID: 36399355 DOI: 10.1093/tropej/fmac100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. METHODS Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. RESULTS The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, β = 14.7, 95% confidence interval [4.7-45.9]). CONCLUSION We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.
Collapse
Affiliation(s)
- Salih Demirhan
- Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Nilgun Karadag
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Elif Ozalkaya
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Guner Karatekin
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Kharrat A, Ripstein G, Baczynski M, Zhu F, Ye XY, Joye S, Jain A. Validity of the vasoactive-inotropic score in preterm neonates receiving cardioactive therapies. Early Hum Dev 2022; 173:105657. [PMID: 36087459 DOI: 10.1016/j.earlhumdev.2022.105657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vasoactive-Inotropic Score (VIS) is a weighted sum of various vasopressors and inotropes; its utility among preterm neonates is understudied. OBJECTIVE To investigate the association between maximum VIS (VISmax) during the first 12, 24 and 48 h of treatment among preterm neonates who received vasopressors/inotropes, and the composite outcome of death/severe neuroinjury (sNI). METHODS Retrospective cohort study, over 6-years, including neonates <35 weeks gestational age (GA). Infants who met the primary composite outcome of death or sNI (defined as new intraventricular hemorrhage ≥grade 3 or periventricular leukomalacia) were compared to those who survived without sNI. Maximum VIS was categorized as <10, 10-19 or ≥ 20 for comparison. RESULTS 192 infants (mean GA and birth weight 26.8 ± 3.3 weeks and 952 ± 528 g, respectively) were included. The most common primary diagnosis was sepsis/necrotizing enterocolitis (69 %). Median VIS for the entire cohort was 10. Death/sNI was associated with lower GA at birth and treatment, as well as higher frequency of VISmax of 10-19 or ≥20, compared to <10, during each time period (all p < 0.01). Multivariable regression revealed GA at treatment and VISmax ≥ 20 [not 10-19, referenced to <10] were associated death/sNI; adjusted odds ratio (95 % CI) for VISmax ≥ 20 within 12, 24, and 48 h were 4.2 (1.6-11.0), 4.9 (1.9-12.3), and 6.7 (2.7-16.7), respectively. CONCLUSIONS Vasoactive-Inotropic Score may be a valid measure to quantify cardiovascular support in preterm infants needing hemodynamic support. Maximum VIS ≥20 within 48 h of treatment initiation may identify patients at high risk of adverse outcomes.
Collapse
Affiliation(s)
- Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
| | | | - Michelle Baczynski
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Faith Zhu
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastien Joye
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
9
|
Risk factors for the in-hospital mortality of CRRT-therapy patients with cardiac surgery-associated AKI: a single-center clinical study in China. Clin Exp Nephrol 2022; 26:1233-1239. [PMID: 36083528 DOI: 10.1007/s10157-022-02274-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We retrospectively analyzed risk factors on in-hospital mortality in CRRT-therapy patients with open cardiac surgery (CS)-induced acute kidney injury (AKI), to provide the clinical basis for predicting and lowering the in-hospital mortality after CS. METHODS 84 CS-AKI patients with CRRT were divided into survival and death groups according to discharge status, and the perioperative data were analyzed with R version 4.0.2. RESULTS There were significant differences between the two groups, including: urea nitrogen, Sequential Organ Failure Assessment (SOFA) score and vasoactive-inotropic score (VIS) on the first day after operation; VIS just before CRRT; SOFA score and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, severe infection and MODS after operation; and the interval between AKI and CRRT. Univariate logistic regression analysis showed that SOFA score and VIS on the first day after operation; VIS just before CRRT; VIS and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, infection and multiple organ dysfunction syndrome (MODS) after operation; bootstrap resampling analysis showed that SOFA score and VIS 24 h after CRRT, as well as the incidence of bleeding after operation were the independent risk factors. CONCLUSION Maintaining stable hemodynamics and active prevention of bleeding are expected to decrease the in-hospital mortality.
Collapse
|
10
|
Pollak U, Abarbanel I, Salem Y, Serraf AE, Mishaly D. Dominant Ventricular Morphology and Early Postoperative Course After the Fontan Procedure. World J Pediatr Congenit Heart Surg 2022; 13:346-352. [PMID: 35446208 PMCID: PMC9024023 DOI: 10.1177/21501351221081246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Single ventricle heart disease comprises a wide variety of critical heart defects that lead to the provision of systemic cardiac output by one dominant ventricle. It requires staged surgical palliation that culminates in Fontan circulation. Dominant ventricular morphology in single ventricle patients reportedly has an impact on postoperative morbidity and mortality with varying results. The objectives of this study were to examine the association between ventricular morphology and the early postoperative course after the Fontan procedure. Methods A retrospective cohort study in a tertiary referral pediatric medical center that included 98 consecutive patients who underwent Fontan procedure between October 2009 and May 2016. Postoperative outcomes were compared between patients with left ventricular morphology and those with right ventricular morphology (crude effect and regression analysis). Results Patients with right ventricular morphology had longer postoperative hospitalizations compared to patients with left ventricular morphology (26.5 days vs 18.2 days, respectively, P = .028), higher postoperative maximal vasoactive-inotropic scores (25.6 vs 12.4, P = .02), higher serum lactate levels (7.7 mmol/L vs 6.4 mmol/L, P = .03), higher proportions of ventilation throughout 24 h or more (16 patients [38%] vs 8 patients [14%], P = .009), higher proportions of ventricular dysfunction (12 patients [29%] vs 5 patients [9%], P = .0001), and lower blood oxygen saturation levels at discharge (87% vs 92%, P = .03). Conclusions The Fontan procedure in patients with right ventricular morphology is associated with longer postoperative hospitalization and worse early postoperative characteristics (ventricular dysfunction and atrioventricular valve regurgitation) as well as higher rates of early, transient signs of sub-optimal postoperative hemodynamics compared to those with left ventricular morphology.
Collapse
Affiliation(s)
- Uri Pollak
- Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Jerusalem, Israel.,Pediatric Cardiology, Hadassah University Medical Center, Jerusalem, Israel.,Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Jerusalem, Israel.,58884The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Inbar Abarbanel
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Yishay Salem
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric Cardiology, Edmond J. Safra International Congenital Heart Center, 146925The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Alain E Serraf
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, 26744The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, 26744The Chaim Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
11
|
Relation of Left Ventricular Assist Device Infections With Cardiac Transplant Outcomes. Am J Cardiol 2021; 160:67-74. [PMID: 34615608 DOI: 10.1016/j.amjcard.2021.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
Left ventricular assist device (LVAD)-specific infections (LSIs) are common in patients on LVAD support awaiting heart transplant (HT), yet their impact on post-HT outcomes is not completely understood. We hypothesized that LSIs would result in vasoplegia and negatively affect post-HT 30-day and 1-year outcomes. LSI was defined as driveline, pump, or pocket infection. The short-term outcome was a composite of acute renal failure, allograft rejection, and mortality at 30 days after HT. The long-term outcome was a composite of allograft rejection and death within 1 year after HT. We performed a retrospective analysis of 111 HT recipients bridged with durable LVAD support at our institution from May 2012 to August 2019. Of these, 63 patients had LSIs, with 94% of the infections being driveline infections. Vasoplegia was more prevalent in the LSI group but not significantly (7 vs 2 persons, p = 0.3). There was no difference in the composite end point of acute renal failure, rejection, or death at 30 days (30% vs 25%, p = 0.55) or 1-year end point of rejection and death (38% vs 40%, p = 0.87) in patients with LSI versus those without LSI. In conclusion, LSIs were common in patients on LVAD who underwent HT in our single-center contemporary cohort. However, LSI was not associated with adverse outcomes at 30 days or at 1 year after HT.
Collapse
|
12
|
Belletti A, Lerose CC, Zangrillo A, Landoni G. Vasoactive-Inotropic Score: Evolution, Clinical Utility, and Pitfalls. J Cardiothorac Vasc Anesth 2021; 35:3067-3077. [DOI: 10.1053/j.jvca.2020.09.117] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
|
13
|
Venema CS, Erasmus ME, Mariani M, Voors AA, Damman K. Post-transplant inotrope score is associated with clinical outcomes after adult heart transplantation. Clin Transplant 2021; 35:e14347. [PMID: 33969543 PMCID: PMC8519078 DOI: 10.1111/ctr.14347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inotrope score has been proposed as a marker of clinical outcome after adult heart transplantation (HTx) but is rarely used in practice. METHODS Inotrope score during the first 48 h after HTx was calculated in 81 patients as: dopamine + dobutamine + amrinone + milrinone (dose × 15) + epinephrine (dose × 100) + norepinephrine (dose × 100) + enoximone + isoprenaline (dose × 100), with each drug in µg/kg/min. Determinants of inotrope score were identified with linear regression. Cox regression was used to determine the association of inotrope score with mortality. RESULTS The mean recipient age was 52 ± 11 years, and 32 (39.5%) patients were female. Determinants of inotrope score were preoperative C-reactive protein, serum urea, congenital heart disease, and donor cardiac arrest (R2 = .30). Inotrope score was associated with 5-year mortality, independent of recipient age and gender (HR 1.03, 95% CI 1.00-1.07). This association was attenuated when adjusting for female-to-male transplant and ischemia time. Inotrope score was also strongly associated with continuous veno-venous hemofiltration (OR 1.07, 95% CI 1.03-1.12). CONCLUSION High inotrope score post-HTx was observed in recipient congenital heart disease and was associated with a higher risk of mortality and acute kidney injury.
Collapse
Affiliation(s)
- Constantijn S. Venema
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Michiel E. Erasmus
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Massimo Mariani
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Adriaan A. Voors
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kevin Damman
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
14
|
Differential Prognostic Implications of Vasoactive Inotropic Score for Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock According to Use of Mechanical Circulatory Support. Crit Care Med 2021; 49:770-780. [PMID: 33590998 DOI: 10.1097/ccm.0000000000004815] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify whether the prognostic implications of Vasoactive Inotropic Score according to use of mechanical circulatory support differ in the treatment of acute myocardial infarction complicated by cardiogenic shock. DESIGN A multicenter retrospective and prospective observational cohort study. SETTING/PATIENT The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy registry includes 1,247 patients with cardiogenic shock from 12 centers in Korea. A total of 836 patients with acute myocardial infarction complicated by cardiogenic shock were finally selected, and the study population was stratified by quartiles of Vasoactive Inotropic Score (< 10, 10-30, 30-90, and > 90) for the present study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary endpoint was in-hospital mortality and secondary endpoint was follow-up mortality. Among the study population, 326 patients (39.0%) received medical treatment alone, 218 (26.1%) received intra-aortic balloon pump, and 292 (34.9%) received extracorporeal membrane oxygenation. In-hospital mortality occurred in 305 patients (36.5%) and was significantly higher in patients with higher Vasoactive Inotropic Score (15.6%, 20.8%, 40.2%, and 67.3%, for < 10, 10-30, 30-90, and > 90; p < 0.001). Vasoactive Inotropic Score showed better ability to predict in-hospital mortality in acute myocardial infarction patients with cardiogenic shock who received medical treatment alone (area under the curve: 0.797; 95% CI, 0.728-0.865) than in those who received intra-aortic balloon pump (area under the curve, 0.704; 95% CI, 0.625-0.783) or extracorporeal membrane oxygenation (area under the curve, 0.644; 95% CI, 0.580-0.709). The best cutoff value of Vasoactive Inotropic Score for the prediction of in-hospital mortality also differed according to the use of mechanical circulatory support (16.5, 40.1, and 84.0 for medical treatment alone, intra-aortic balloon pump, and extracorporeal membrane oxygenation, respectively). There was a significant interaction between Vasoactive Inotropic Score as a continuous value and the use of mechanical circulatory support including intra-aortic balloon pump (interaction-p = 0.006) and extracorporeal membrane oxygenation (interaction-p < 0.001) for all-cause mortality during follow-up. CONCLUSIONS High Vasoactive Inotropic Score was associated with significantly higher in-hospital and follow-up mortality in patients with acute myocardial infarction complicated by cardiogenic shock. The predictive value of Vasoactive Inotropic Score for mortality was significantly higher in acute myocardial infarction patients with cardiogenic shock treated by medical treatment alone than in those treated by mechanical circulatory support such as intra-aortic balloon pump or extracorporeal membrane oxygenation.
Collapse
|
15
|
Dilli D, Akduman H, Orun UA, Tasar M, Tasoglu I, Aydogan S, Citli R, Tak S. Predictive Value of Vasoactive-inotropic Score for Mortality in Newborns Undergoing Cardiac Surgery. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1639-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Han J, Pinsino A, Sanchez J, Takayama H, Garan AR, Topkara VK, Naka Y, Demmer RT, Kurlansky PA, Colombo PC, Takeda K, Yuzefpolskaya M. Prognostic value of vasoactive-inotropic score following continuous flow left ventricular assist device implantation. J Heart Lung Transplant 2019; 38:930-938. [PMID: 31201088 PMCID: PMC9891263 DOI: 10.1016/j.healun.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the utility of vasoactive-inotropic score (VIS) in predicting outcomes after left ventricular assist device (LVAD) implantation and explore possible mechanisms of post-operative hemodynamic instability. METHODS Retrospective review was performed in 418 consecutive patients with LVAD implantation. VIS was calculated as dopamine + dobutamine + 10 × milrinone + 100 × epinephrine + 100 × norepinephrine (all μg/kg/min) + 10000 × vasopressin (U/kg/min) after initial stabilization in the operating room and upon arrival at the intensive care unit. The primary outcome was in-hospital mortality. The secondary outcomes were a composite of in-hospital mortality, delayed right ventricular assist device (RVAD) implantation, and continuous renal replacement therapy. The pre-operative biomarkers of inflammation, oxidative stress, endotoxemia and gut-derived metabolite trimethylamine-N-oxide (TMAO) were measured in a subset of 61 patients. RESULTS Median VIS was 20.0 (interquartile range 13.3-27.9). VIS was an independent predictor of in-hospital mortality (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09, p < 0.001) and composite outcome (OR 1.03, 95% CI 1.01-1.06, p = 0.008). In-hospital mortality increased for each VIS quartile (0% vs 3.9% vs 7.6% vs 12.3%, p = 0.002). VIS was superior to other established LVAD risk models as a predictor of in-hospital mortality (area under the curve 0.73, 95% CI 0.64-0.82). The optimal cut-off point for VIS as a predictor of in-hospital mortality was 20. Pre-operative hemoglobin level was the only independent predictor of VIS ≥ 20 (p = 0.003). Patients with a high VIS were more likely to have elevated TMAO pre-operatively (53.6% vs 25.8%, p = 0.03). CONCLUSIONS A high post-operative VIS is associated with adverse in-hospital outcomes and is a better predictor of in-hospital mortality compared with existing LVAD risk models. Whether early hemodynamic stabilization using RVAD may benefit patients with a high VIS remains to be investigated.
Collapse
Affiliation(s)
- Jiho Han
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joseph Sanchez
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
| |
Collapse
|
17
|
Mueller MF, Paul AC, Mann V, Koerner CM, Valeske K, Thul J, Mazhari N, Bauer J, Schranz D, Akintuerk H. Anesthesia for Pediatric Heart Transplantation: Are Patients With a Failing Hemi-Fontan- or Fontan-Physiology Different? Semin Cardiothorac Vasc Anesth 2019; 23:393-398. [PMID: 31431128 DOI: 10.1177/1089253219870635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The absolute number of patients presenting with failure of the hemi-Fontan or Fontan circulation for cardiac transplantation (cTx) will continuously rise. We aimed to analyze the intraoperative differences in patients undergoing cTx for a failing hemi-Fontan or Fontan circulation (group A) with those undergoing cTx for cardiomyopathy and congenital heart disease (group B). Methods. Data of patients undergoing cTx during a 10-year period were compared between group A and group B patients. Results. cTx was performed in 83 patients (group A, n = 21; group B, n = 62). Surgical times including median incision-suture time (549 minutes vs 386 minutes, P < .05) and median organ ischemia time (305 minutes vs 233 minutes, P < .05) were longer in group A patients. After weaning off cardiopulmonary bypass a higher median modified Vasoactive Inotropic Score (16 vs 10, P < .05) was necessary in group A patients. During surgery more fresh frozen plasma (44 mL/kg vs 20 mL/kg, P < .05), platelet concentrates (20 mL/kg vs 14 mL/kg, P < .05), and coagulation factor concentrates were given in group A patients. Mortality during the first 90 days after cTx was higher in group A (23.8% vs 6.5%, P < .05). Conclusion. Patients undergoing cTx for a failing hemi-Fontan or Fontan circulation are challenging. They require an intensive vasoactive and inotropic support; furthermore, special attention should be paid to the management of bleeding complications. cTx for this group of patients is associated with higher 90 days mortality.
Collapse
Affiliation(s)
- Matthias F Mueller
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Ann-Catrin Paul
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Valesco Mann
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Christian M Koerner
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Klaus Valeske
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Josef Thul
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Noona Mazhari
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Juergen Bauer
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Dietmar Schranz
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Hakan Akintuerk
- Pediatric Heart Center Giessen, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| |
Collapse
|
18
|
Liu Y, An Z, Chen J, Liu Y, Tang Y, Han Q, Lu F, Tang H, Xu Z. Risk factors for noninvasive ventilation failure in patients with post-extubation acute respiratory failure after cardiac surgery. J Thorac Dis 2018; 10:3319-3328. [PMID: 30069328 DOI: 10.21037/jtd.2018.05.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The effect of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF) after cardiac surgery is controversial. This study identified the feasibility of NIV and assessed the risk factors of NIV failure in patients with ARF after cardiac surgery. Methods We retrospectively reviewed data from 112 patients with ARF requiring NIV and categorized them into the NIV failure and success groups. Patient data were extracted for further analysis, the primary outcomes were the need for endotracheal intubation and NIV-related in-hospital mortality. The risk factors for NIV failure in patients with post-extubation ARF was analyzed. Results The median time from extubation to NIV was 11 hours. No difference in the EuroSCORE existed between the two groups. NIV failed in 38.4% of the patients. The NIV failure group had a higher in-hospital mortality and stay at the longer intensive care unit (ICU). Most cases of NIV failure occurred within 1-48 hours of the treatment. The main causes of early NIV failure were a weak cough reflex and/or excessive secretions and hemodynamic instability. A Sequential Organ Failure Assessment (SOFA) score ≥10.5, vasoactive-inotropic score ≥6, and pneumonia were predictors of NIV failure, whereas a body mass index (BMI) ≥25.0 kg/m2 predicted NIV success. Conclusions NIV was effective in the study population. Multiple organ dysfunction, pneumonia, and significant inotropic drug support before NIV were associated with NIV failure, whereas a BMI ≥25 kg/m2 was a predictor of NIV success.
Collapse
Affiliation(s)
- Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhao An
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jinqiang Chen
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yaoyang Liu
- Department of Rheumatology & Immunology, Changzheng Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yangfeng Tang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hao Tang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
19
|
López J, Slöcker M, Heras E, Ríos D, Barrio L, Cebrián R, Gómez D, López-Herce J. Prognostic utility of the multiorgan failure scores and inotropic index in the postoperative of cardiac transplantation in children. Med Intensiva 2017; 43:441-443. [PMID: 29107393 DOI: 10.1016/j.medin.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J López
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Red de Salud Maternoinfantil y del Desarrollo (red SAMID), Instituto de Salud Carlos III, Madrid, España
| | - M Slöcker
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España
| | - E Heras
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España
| | - D Ríos
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - L Barrio
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - R Cebrián
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - D Gómez
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - J López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Red de Salud Maternoinfantil y del Desarrollo (red SAMID), Instituto de Salud Carlos III, Madrid, España.
| |
Collapse
|
20
|
Garcia RU, Walters HL, Delius RE, Aggarwal S. Vasoactive Inotropic Score (VIS) as Biomarker of Short-Term Outcomes in Adolescents after Cardiothoracic Surgery. Pediatr Cardiol 2016; 37:271-7. [PMID: 26424215 DOI: 10.1007/s00246-015-1273-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
Abstract
Our aim was to evaluate the Vasoactive Inotropic Score (VIS) as a prognostic marker in adolescents following surgery for congenital heart disease. This single-center retrospective chart review included patients 10-18 years of age, who underwent cardiac surgery from 2009 to 2014. Hourly VIS was calculated for the initial 48 postoperative hours using standard formulae and incorporating doses of six pressors. The composite adverse outcome was defined as any one of death, resuscitation or mechanical support, arrhythmia, infection requiring antibacterial therapy, acute kidney injury or neurologic injury. Surgeries were risk-stratified by the type of surgical repair using the validated STAT score. Statistical analysis (SPSS 19.0) included Mann-Whitney U test, Chi-square test, ROC curves, and binary regression analysis. Our cohort (n = 149) had a mean (SD) age of 13.9 (2.4) years and included 97 (65.1 %) males. Maximal VIS at 24 and 48 h following surgery was significantly higher in subjects (n = 27) who suffered an adverse outcome. Subjects with adverse outcome had longer bypass and cross-clamp times, durations of stay in the hospital, and a higher rate of acute kidney injury, compared to those (n = 122) without postoperative adverse outcomes. The area under the ROC for maximum VIS at 24-48 h after surgery was 0.76, with sensitivity, specificity, and positive and negative predictive values with 95 % CI of 67 (48-82) %, 74 (70-77) %, and 36 (26-44) % and 91 (86-95) %, respectively, at a cutoff >4.75. On binary logistic regression, maximum VIS on second postoperative day remained significantly associated with adverse outcome (OR 1.35; 95 % CI> 1.12-1.64, p = 0.002). Maximal VIS at 24 and 48 h correlated significantly with length of stay and time to extubation. Maximal VIS on the second postoperative day predicts adverse outcome in adolescents following cardiac surgery. This simple yet robust prognostic indicator may aid in risk stratification and targeted interventions in this population.
Collapse
Affiliation(s)
- Richard U Garcia
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA.
| | - Henry L Walters
- Division of Cardio-Thoracic Surgery, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ralph E Delius
- Division of Cardio-Thoracic Surgery, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| |
Collapse
|
21
|
A novel pediatric treatment intensity score: development and feasibility in heart failure patients with ventricular assist devices. J Heart Lung Transplant 2015; 34:509-15. [DOI: 10.1016/j.healun.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/17/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022] Open
|
22
|
Kumar M, Sharma R, Sethi SK, Bazaz S, Sharma P, Bhan A, Kher V. Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery. Indian J Crit Care Med 2014; 18:653-8. [PMID: 25316975 PMCID: PMC4195195 DOI: 10.4103/0972-5229.142174] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neonates and infants undergoing heart surgery on cardiopulmonary bypass (CPB) are at high risk for significant post-operative morbidity and mortality. Hence, there is a need to identify and quantify clinical factors during the early post-operative period that are indicative of short-term as well as long-term outcomes. Multiple inotrope scores have been used in practice to quantify the amount of cardiovascular support received by neonates. AIMS The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcomes in children after open cardiac surgery. MATERIALS AND METHODS This is a retrospective analysis of the 208 patients who underwent cardiac surgery for congenital heart disease at a tertiary pediatric cardiac surgery Intensive Care Unit (ICU) from January 2012 to March 2013. Multiple demographic, intra-operative and post-operative variables were recorded, including the Vasoactive Inotrope Score (VIS). RESULTS A total of 208 patients underwent cardiac surgery for congenital heart disease in the study period. The mean age and weight in the study were 66.94 months and 16.31 kg, respectively. Statistically significant associations were found in the various variables and VIS, including infancy, weight < 10 kg, CPB time, pump failure and post-operative variables like sepsis, hematological complications, hepatic dysfunction, acute kidney injury during admission, mortality, prolonged ventilator requirement, CPB time (in min) and hospital stay. CONCLUSIONS Inotrope score and its adaptations are an excellent tool to measure illness severity, deciding interventions and during parental counseling in the pediatric cardiac surgery ICUs.
Collapse
Affiliation(s)
- Maneesh Kumar
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Rajesh Sharma
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | | | - Subeeta Bazaz
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Prerna Sharma
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Anil Bhan
- Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Vijay Kher
- Cardiothoracic Surgery, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| |
Collapse
|