The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot

Advances in pediatric perioperative care using artificial intelligence

PURPOSE OF THIS REVIEW

This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers.

RECENT FINDINGS

The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools.

SUMMARY

The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.

Use of artificial intelligence in paediatric anaesthesia: a systematic review

Objectives

Although the development of artificial intelligence (AI) technologies in medicine has been significant, their application to paediatric anaesthesia is not well characterised. As the paediatric operating room is a data-rich environment that requires critical clinical decision-making, this systematic review aims to characterise the current use of AI in paediatric anaesthesia and to identify barriers to the successful integration of such technologies.

Methods

This review was registered with PROSPERO (CRD42022304610), the international registry for systematic reviews. The search strategy was prepared by a librarian and run in five electronic databases (Embase, Medline, Central, Scopus, and Web of Science). Collected articles were screened by two reviewers. Included studies described the use of AI for paediatric anaesthesia (<18 yr old) within the perioperative setting.

Results

From 3313 records identified in the initial search, 40 were included in this review. Identified applications of AI were described for patient risk factor prediction (24 studies; 60%), anaesthetic depth estimation (2; 5%), anaesthetic medication/technique decision guidance (2; 5%), intubation assistance (1; 2.5%), airway device selection (3; 7.5%), physiological variable monitoring (6; 15%), and operating room scheduling (2; 5%). Multiple domains of AI were discussed including machine learning, computer vision, fuzzy logic, and natural language processing.

Conclusion

There is an emerging literature regarding applications of AI for paediatric anaesthesia, and their clinical integration holds potential for ultimately improving patient outcomes. However, multiple barriers to their clinical integration remain including a lack of high-quality input data, lack of external validation/evaluation, and unclear generalisability to diverse settings.

Systematic review protocol

CRD42022304610 (PROSPERO).

Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction

A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

Investigation of associated factors with post-operative outcomes in patients undergoing Tetralogy of Fallot correction

Background

Tetralogy of Fallot (TOF) is one of the congenital cardiac abnormality which occurs during embryonic time. Although surgical correction, especially early operation, is the best way to treat patients, still contributing factors in morbidity and mortality is controversial. The objective of this study is to investigate potential factors which might be correlated with post-operative outcomes of TOF.

Methods

In this retrospective study, 349 monitored patients with TOF correction were selected. Median of age was 4 (0.66–8) year, 58% of patients were male and 42% were female. Time of inotropic drug, extubation time, and ICU stay were considered as post-operative outcomes which extension of each of them increased the risk of death.

Results

Ventricular septal defect enlargement was associated with longer extubation time and ICU stay. Higher ratio of pre-operative haematocrit was correlated with mortality (0.047).

Conclusions

Results of this study demonstrated that haematocrit ratio before operation should be considered as a predictive factor, and patients with higher ratio of haematocrit require more care after operation. VSD enlargement is associated with longer extubation time and ICU stay.