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Chang Junior J, Caneo LF, Turquetto ALR, Amato LP, Arita ECTC, Fernandes AMDS, Trindade EM, Jatene FB, Dossou PE, Jatene MB. Predictors of in-ICU length of stay among congenital heart defect patients using artificial intelligence model: A pilot study. Heliyon 2024; 10:e25406. [PMID: 38370176 PMCID: PMC10869777 DOI: 10.1016/j.heliyon.2024.e25406] [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] [Received: 03/08/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Objective This study aims to develop a predictive model using artificial intelligence to estimate the ICU length of stay (LOS) for Congenital Heart Defects (CHD) patients after surgery, improving care planning and resource management. Design We analyze clinical data from 2240 CHD surgery patients to create and validate the predictive model. Twenty AI models are developed and evaluated for accuracy and reliability. Setting The study is conducted in a Brazilian hospital's Cardiovascular Surgery Department, focusing on transplants and cardiopulmonary surgeries. Participants Retrospective analysis is conducted on data from 2240 consecutive CHD patients undergoing surgery. Interventions Ninety-three pre and intraoperative variables are used as ICU LOS predictors. Measurements and main results Utilizing regression and clustering methodologies for ICU LOS (ICU Length of Stay) estimation, the Light Gradient Boosting Machine, using regression, achieved a Mean Squared Error (MSE) of 15.4, 11.8, and 15.2 days for training, testing, and unseen data. Key predictors included metrics such as "Mechanical Ventilation Duration", "Weight on Surgery Date", and "Vasoactive-Inotropic Score". Meanwhile, the clustering model, Cat Boost Classifier, attained an accuracy of 0.6917 and AUC of 0.8559 with similar key predictors. Conclusions Patients with higher ventilation times, vasoactive-inotropic scores, anoxia time, cardiopulmonary bypass time, and lower weight, height, BMI, age, hematocrit, and presurgical oxygen saturation have longer ICU stays, aligning with existing literature.
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Affiliation(s)
- João Chang Junior
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
- Escola Superior de Engenharia e Gestão - ESEG, Rua Apeninos, 960, São Paulo, Brazil
- Centro Universitário Armando Alvares Penteado - FAAP, Rua Alagoas, 903, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
| | - Aida Luiza Ribeiro Turquetto
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
- Núcleo de Avaliação de Tecnologias da Saúde - NATS-HCFMUSP, Brazil
| | - Luciana Patrick Amato
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
- Núcleo de Avaliação de Tecnologias da Saúde - NATS-HCFMUSP, Brazil
| | - Elisandra Cristina Trevisan Calvo Arita
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
| | - Alfredo Manoel da Silva Fernandes
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
| | - Evelinda Marramon Trindade
- Núcleo de Avaliação de Tecnologias da Saúde - NATS-HCFMUSP, Brazil
- Laboratório de Ensino, Pesquisa e Inovação Em Saúde - LEPIC-HCFMUSP, Superintendência / Hospital Das Clínicas da FMUSP, Rua Dr. Ovidio Pires de Campos, 225, 5°. Andar – Superintendência, Sao Paulo, Brazil
- Sao Paulo State Health Secretariat–SES-SP, Sao Paulo, Brazil
| | - Fábio Biscegli Jatene
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
| | - Paul-Eric Dossou
- Institut Catholique des Arts et Metiers–Icam, Paris-Senart, France
| | - Marcelo Biscegli Jatene
- Hospital Das Clínicas HCFMUSP, Universidade de São Paulo, Instituto Do Coração - InCor, Av. Dr. Enéas Carvalho de Aguiar, 44, CEP 05403-000, São Paulo, Brazil
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Kesumarini D, Widyastuti Y, Boom CE, Dinarti LK. Risk Factors Associated With Prolonged Mechanical Ventilation and Length of Stay After Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2024; 15:81-88. [PMID: 37769605 DOI: 10.1177/21501351231191456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study examined preoperative, intraoperative, and postoperative data to identify factors that are associated with prolonged mechanical ventilation (PMV) and prolonged intensive care unit length of stay (ICU LOS) in tetralogy of Fallot (TOF) patients undergoing repair surgery. METHODS A retrospective study was carried out after approval from the institutional review board. All patients (age 0-52 years) who underwent TOF repair from January 2016 to September 2022 were included. Prolonged mechanical ventilation was defined as >24 h of ventilation, while prolonged ICU LOS was defined as ICU stay >3 days. RESULTS A total of 922 patients were included, among whom 288 (31.2%) were intubated for >24 h and 222 (24.1%) stayed in ICU for >3 days. Younger age (odds ratio [OR] = 2, 95% confidence interval [CI] 1.2-3.3, P = .007), lower weight (OR = 2.1, 95% CI 1.2-3.5, P = .003), and residual lesion (OR = 3.27, 95% CI 1.2-8.7, P = .017) were associated with PMV. Moreover, independent risk factors for prolonged ICU LOS are similar to PMV risk factors, including younger age (OR = 2.3, 95% CI 1.28-4.12, P = .005), lower weight (OR = 2.83, 95% CI 1.58-5, P < .001), underweight status (OR = 1.7, 95% CI 1.12-2.57, P = .012), and residual lesion (OR = 3.79, 95% CI 1.43-10.05, P = .007). Both aortic cross-clamp and cardiopulmonary bypass times did not exhibit clinically significant risk factors toward PMV and prolonged ICU LOS. CONCLUSIONS The risk factors for PMV and prolonged ICU LOS were residual lesion, younger age, and lower weight. Nutritional status contributed to the risk of prolonged ICU LOS, but not PMV. Consideration of these factors may provide optimal care to improve the outcome following TOF corrective surgery.
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Affiliation(s)
- Dian Kesumarini
- Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Doctoral Programme, Faculty of Medicine and Public Health University of Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Department of Anesthesia and Intensive Therapy, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Cindy Elfira Boom
- Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
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Barajas-Romero JS, Vásquez-Hoyos P, Pardo R, Jaramillo-Bustamante JC, Grigolli R, Monteverde-Fernández N, Gonzalez-Dambrauskas S, Jabornisky R, Cruces P, Wegner A, Díaz F, Pietroboni P. Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry. Med Intensiva 2024; 48:23-36. [PMID: 37481458 DOI: 10.1016/j.medine.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN Secondary analysis of a prospective cohort. SETTING PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.
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Affiliation(s)
| | - Pablo Vásquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Nacional de Colombia, Bogotá, Colombia; Sociedad de Cirugía de Bogota Hospital de San José, FUCS, Bogotá, Colombia.
| | - Rosalba Pardo
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Clínica Infantil de Colsubsidio, Bogotá, Colombia
| | - Juan Camilo Jaramillo-Bustamante
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital General de Medellín Luz Castro de Gutiérrez E.S.E., Medellín, Colombia
| | - Regina Grigolli
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Infantil Sabará, Sao Paulo, Brazil
| | | | - Sebastián Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Roberto Jabornisky
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Juan Pablo II, Corrientes, Argentina; Hospital Regional Olga Stucky de Rizzi, Reconquista, Argentina
| | - Pablo Cruces
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Andres Bello, Facultad de Ciencias de la Vida, Santiago, Chile
| | - Adriana Wegner
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital El Carmen de Maipú, Dr. Luis Valentín Ferrada, Santiago, Chile; Unidad de Investigación y Epidemiología Clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Pietro Pietroboni
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Regional de Antofagasta, Antofagasta, Chile
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Jothinath K, Raju V, Nemergut ME, Arteaga GM, Ramanath P, Vijayalakshmi T. Effects of on-table extubation on resource utilization and maternal anxiety in children undergoing congenital heart surgery in a low-resource environment. Ann Pediatr Cardiol 2023; 16:399-406. [PMID: 38817266 PMCID: PMC11135879 DOI: 10.4103/apc.apc_162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 06/01/2024] Open
Abstract
Objective To study the applicability of on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety. Materials and Methods In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI). Results Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (P < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900) , approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, P < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, P < 0.05). Conclusion OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE.
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Affiliation(s)
- Kaushik Jothinath
- Department of Cardiac Anesthesiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Vijayakumar Raju
- Department of Cardiac Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Michael E. Nemergut
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, New York, USA
| | - Grace M Arteaga
- Department of Pediatric Critical Care, Mayo Clinic, Rochester, New York, USA
| | - Pavithra Ramanath
- Department of Research and Statistics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
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Stevens H, Gallant J, Foster J, Horne D, Krmpotic K. Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. J Pediatr Intensive Care 2023; 12:167-172. [PMID: 37565014 PMCID: PMC10411109 DOI: 10.1055/s-0041-1730933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.
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Affiliation(s)
- Hannah Stevens
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Julien Gallant
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Jennifer Foster
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Pediatric Congenital Cardiac Surgery, IWK Health, Halifax, Canada
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Kristina Krmpotic
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
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Kepple JW, Kendall M, Ortmann LA. Impact of Extubation Time on Feeding Outcomes after Neonatal Cardiac Surgery: A Single-Center Study. CHILDREN 2023; 10:children10030592. [PMID: 36980149 PMCID: PMC10047081 DOI: 10.3390/children10030592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023]
Abstract
This study aimed to examine the impact of timing of extubation on feeding outcomes in neonates after surgery for congenital heart disease. This was a single-center retrospective study between December 2014 and June 2020. Patients were divided into three categories: extubated in the OR (immediate), extubated in the intensive care unit (ICU) between 0 and 3 days post-procedure (early), and extubated >3 days post-procedure (delayed). Comparing the immediate and early groups, we found no difference in time to first enteral feed (1.3 days (1.0–3.4) vs. 2.3 days (1.1–3.3), p = 0.27). There was no difference in time to first oral feed (2.0 days (1.1–4.5) vs. 3.1 days (1.8–4.4), p = 0.34) and time to goal feed (6.0 days (3.2–8.3) vs. 6.9 days (5.0–9.0), p = 0.15)). There was no difference in all oral feeds at one year: 88% vs. 98%, p = 0.16. The delayed extubation group performed significantly worse on all measures. Immediate and early extubation displayed no differences in feeding outcomes and length of stay in this study, while delayed extubation performed worse on all measures. Thus, we believe that clinicians should emphasize extubation within 3 days post-surgery to improve feeding outcomes while minimizing time hospitalized.
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Affiliation(s)
- Jeffrey W. Kepple
- Department of Pediatrics, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Meghan Kendall
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA
| | - Laura A. Ortmann
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA
- Correspondence:
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Habet V, Li N, Qi J, Peng G, Charkoftaki G, Vasiliou V, Sharma L, Pober JS, Dela Cruz C, Yan X, Pierce RW. Integrated Analysis of Tracheobronchial Fluid from Before and After Cardiopulmonary Bypass Reveals Activation of the Integrated Stress Response and Altered Pulmonary Microvascular Permeability. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:23-42. [PMID: 37009190 PMCID: PMC10052603 DOI: 10.59249/kfyz8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Objective: We aim to comprehensively describe the transcriptional activity and signaling of pulmonary parenchymal and immune cells before and after cardiopulmonary bypass (CPB) by using a multi-omic approach coupled with functional cellular assays. We hypothesize that key signaling pathways from specific cells within the lung alter pulmonary endothelial cell function resulting in worsening or improving disease. Methods: We collected serial tracheobronchial lavage samples from intubated patients less than 2-years-old undergoing surgery with CPB. Samples were immediately processed for single cell RNA sequencing (10x Genomics). Cell clustering, cell-type annotation, and visualization were performed, and differentially expressed genes (DEG) between serial samples were identified. Metabolomic and proteomic analyses were performed on the supernatant using mass spectrometry and a multiplex assay (SomaScan) respectively. Functional assays were done using electric cell-substrate impedance sensing to measure resistance across human pulmonary microvascular endothelial cells (HPMECs). Results: Analysis of eight patients showed a heterogeneous mixture of pulmonary parenchymal and immune cells. Cell clustering demonstrated time-dependent changes in the transcriptomic signature indicating altered cellular phenotypes after CPB. DEG analysis was represented by genes involved in host defense, innate immunity, and the mitochondrial respiratory transport chain. Ingenuity pathway analysis showed upregulation of the integrated stress response across all cell types after CPB. Metabolomic analysis demonstrated upregulation of ascorbate and aldarate metabolism. Unbiased proteomic analysis revealed upregulation of proteins involved in cytokine and chemokine pathways. Post-CPB patient supernatant improved HMPEC barrier function, suggesting a protective cellular response to CPB. Conclusion: Children who undergo CPB for cardiac surgery have distinct cell populations, transcriptional activity, and metabolism that change over time. The response to ischemia-reperfusion injury in the lower airway of children appears to be protective, with the need to identify potential targets through future investigations.
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Affiliation(s)
- Victoria Habet
- Department of Pediatrics, Section of Critical Care
Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ningshan Li
- Department of Biostatistics, Yale School of Public
Health, New Haven, CT, USA
| | - Ji Qi
- Department of Biostatistics, Yale School of Public
Health, New Haven, CT, USA
| | - Gang Peng
- Department of Biostatistics, Yale School of Public
Health, New Haven, CT, USA
| | - Georgia Charkoftaki
- Department of Epidemiology, Yale School of Public
Health, New Haven, CT, USA
| | - Vasilis Vasiliou
- Department of Epidemiology, Yale School of Public
Health, New Haven, CT, USA
| | - Lokesh Sharma
- Department of Internal Medicine, Center for Pulmonary
Personalized Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine,
Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of Pulmonary,
Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT,
USA
| | - Jordan S. Pober
- Department of Immunobiology, Yale School of Medicine,
New Haven, CT, USA
| | - Charles Dela Cruz
- Department of Internal Medicine, Center for Pulmonary
Personalized Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine,
Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of Pulmonary,
Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT,
USA
| | - Xiting Yan
- Department of Biostatistics, Yale School of Public
Health, New Haven, CT, USA
- Department of Internal Medicine, Center for Pulmonary
Personalized Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine,
Yale School of Medicine, New Haven, CT, USA
| | - Richard W. Pierce
- Department of Pediatrics, Section of Critical Care
Medicine, Yale School of Medicine, New Haven, CT, USA
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Martins RS, Waqar U, Raza HA, Memon MKY, Akhtar S. Assessing Risk Factors for Prolonged Intensive Care Unit Stay After Surgery for Adult Congenital Heart Disease: A Study From a Lower-Middle-Income Country. Cureus 2023; 15:e35606. [PMID: 37007353 PMCID: PMC10063249 DOI: 10.7759/cureus.35606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Background Prolonged post-surgery intensive care unit (ICU) stay for congenital heart disease (CHD) has been explored in the pediatric population. However, there is limited data for adult CHD (ACHD), also called grown-up congenital heart (GUCH) disease, especially in low-resource countries where intensive care beds are scarce. This study identifies factors associated with prolonged ICU stay following surgery for ACHD in Pakistan, a lower-middle-income country (LMIC). Methods This retrospective study included all adult patients (⩾18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011-2016 at a tertiary-care private hospital in Pakistan. Prolonged ICU stay was defined as stay >6 days (75th percentile). Regression analysis was used to explore risk factors of prolonged ICU stay. Results A total of 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years were included. Atrial septal defect repair was the most common surgery (42.2%). Most patients were categorized as Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) Category 1 (51.8%) and Category 2 (30.1%). Forty-three of 166 patients (25.9%) experienced prolonged ICU stay. Complications occurred in 38.6% of patients postoperatively, with the most common being acute kidney injury (29.5%). On multivariable logistic regression adjusted for age, gender, and RACHS-1 categories, intraoperative inotrope score, cardiopulmonary bypass time, aortic cross-clamp time duration of mechanical ventilation, and postoperative acute kidney injury (AKI) were associated with prolonged ICU stay. Conclusion Surgeons managing ACHD in LMICs must strive for shorter operative durations and the judicious use of intraoperative inotropes in addition to anticipating and promptly managing postoperative complications such as AKI, to minimize ICU stay in countries where intensive care beds are a scarce resource.
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Vasoactive Ventilation Renal Score in Predicting Pediatric Cardiac Surgical Outcomes: As Good as It Gets? Pediatr Cardiol 2023; 44:502-503. [PMID: 36585995 DOI: 10.1007/s00246-022-03092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
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Liu Q, Luo Q, Li Y, Wu X, Wang H, Huang J, Jia Y, Yuan S, Yan F. A simple-to-use nomogram for predicting prolonged mechanical ventilation for children after Ebstein anomaly corrective surgery: a retrospective cohort study. BMC Anesthesiol 2023; 23:24. [PMID: 36639642 PMCID: PMC9839444 DOI: 10.1186/s12871-022-01942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children. METHODS The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve. RESULTS Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05. CONCLUSIONS We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery.
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Affiliation(s)
- Qiao Liu
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Qipeng Luo
- grid.411642.40000 0004 0605 3760Department of Pain Medicine, Peking University Third Hospital, Beijing, China
| | - Yinan Li
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Xie Wu
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Hongbai Wang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Jiangshan Huang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Yuan Jia
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Su Yuan
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Fuxia Yan
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
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Li M, Wang S, Zhang H, Zhang H, Wu Y, Meng B. The predictive value of pressure recording analytical method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGBoost-based machine learning model. Front Cardiovasc Med 2022; 9:1036340. [PMID: 36386354 PMCID: PMC9649993 DOI: 10.3389/fcvm.2022.1036340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Objective Prolonged mechanical ventilation in children undergoing cardiac surgery is related to the decrease in cardiac output. The pressure recording analytical method (PRAM) is a minimally invasive system for continuous hemodynamic monitoring. To evaluate the postoperative prognosis, our study explored the predictive value of hemodynamic management for the duration of mechanical ventilation (DMV). Methods This retrospective study included 60 infants who underwent cardiac surgery. Cardiac index (CI), the maximal slope of systolic upstroke (dp/dtmax), and cardiac cycle efficiency (CCE) derived from PRAM were documented in each patient 0, 4, 8, and 12 h (T0, T1, T2, T3, and T4, respectively) after their admission to the intensive care unit (ICU). A linear mixed model was used to deal with the hemodynamic data. Correlation analysis, receiver operating characteristic (ROC), and a XGBoost machine learning model were used to find the key factors for prediction. Results Linear mixed model revealed time and group effect in CI and dp/dtmax. Prolonged DMV also have negative correlations with age, weight, CI at and dp/dtmax at T2. dp/dtmax outweighing CI was the strongest predictor (AUC of ROC: 0.978 vs. 0.811, p < 0.01). The machine learning model suggested that dp/dtmax at T2 ≤ 1.049 or < 1.049 in combination with CI at T0 ≤ 2.0 or >2.0 can predict whether prolonged DMV (AUC of ROC = 0.856). Conclusion Cardiac dysfunction is associated with a prolonged DMV with hemodynamic evidence. CI measured by PRAM immediately after ICU admission and dp/dtmax 8h later are two key factors in predicting prolonged DMV.
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Gil D, Aljiffry A, Dryer R, Rao N, Figueroa J, Downey L, Shaw FR, Beshish AG. Extubation delays and the associated prostaglandin and opiate dose following coarctation of the aorta repair. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Utilisation of RAM cannula for non-invasive respiratory support for infants in the cardiac ICU. Cardiol Young 2021; 31:1907-1913. [PMID: 33818344 DOI: 10.1017/s1047951121001062] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with CHD carry an additional burden of pulmonary insufficiency, often necessitating prolonged ventilatory support, especially in the peri-operative phase. There has been an increase in the utilisation of non-invasive ventilatory support for these children. The objective of this study was to evaluate the utilisation, safety, and outcomes of RAM cannula as a tool for escalation and de-escalation of respiratory support in paediatric cardiac patients less than one year of age. METHODS A single-centre retrospective cohort study of patients supported with RAM cannula. RESULTS A total of 275 instances of RAM use were included in the study, 81.1% being post-operative. Patients were stratified into escalation and de-escalation cohorts based on the indication of non-invasive ventilation. The success rate of using RAM cannula was 69.5% overall, 66.1% in the escalation group, and 72.8% in the de-escalation group. At baseline, age at cardiac ICU admission >30 days, FiO2 ≤ 40%, PaCO2 ≤ 50 mmHg; and after 12 hours of non-invasive ventilation support respiratory rate ≤ 60/min, PaO2 ≥ 50 mmHg, PaCO2 ≤ 50 mmHg; and absence of worsening on follow-up chest X-ray predicted the success with a sensitivity of 95% in the logistic regression model. Successful support was associated with a significantly shorter unit stay. CONCLUSIONS RAM cannula can be safely used to provide non-invasive support to infants in the cardiac ICU for escalation and de-escalation of respiratory support. Factors associated with success can be used to make decisions about candidacy and appropriate timing of non-invasive ventilation use to maximise effectiveness.
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Preoperative Thoracic CT Findings Associated With Postoperative Mechanical Ventilation in Patients Undergoing Major Abdominal or Pelvic Surgery: A Matched Case-Control Study. AJR Am J Roentgenol 2021; 218:279-288. [PMID: 34467781 DOI: 10.2214/ajr.21.26411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Postoperative prolonged mechanical ventilation is associated with increased morbidity and mortality. Reliable predictors of postoperative mechanical ventilation after abdominal or pelvic surgeries are lacking. Objective: To explore associations between preoperative thoracic CT findings and need for postoperative mechanical ventilation after major abdominal or pelvic surgeries. Methods: This retrospective case-control study included patients who underwent abdominal or pelvic surgeries (01/01/2014-12/31/2018) and underwent preoperative thoracic CT. Cases were patients who required postoperative mechanical ventilation. Control and case patients were matched at a 3:1 ratio based on age, sex, body mass index, chronic obstructive pulmonary disease, smoking status, and surgery type. Two radiologists (R1, R2) reviewed CT images. Findings were compared between groups. Results: The study included 165 patients (70 female, 95 male; mean age 67.0±9.7 years; 42 cases, 123 matched controls). Bronchial wall thickening and pericardial effusion were more frequent in cases than controls for R2 (10% vs 2%, p=.03; 17% vs 5%, p=.01), but not R1. Pulmonary artery diameter was greater in cases than controls for R2 (2.9±0.5 cm vs 2.8±0.5 cm, p=.045) but not R1. Right lung height was lower in cases than controls for R1 (18.4±2.9 cm vs 19.9±2.7 cm, p=.01) and R2 (18.3±2.9 cm vs 19.8±2.7 cm, p=.01). Left lung height was lower in cases than controls for R1 (19.5±3.1 cm vs 21.1±2.6 cm, p=.01) and R2 (19.6±2.4 cm vs 20.9±2.6 cm, p=.01). Anteroposterior chest diameter was greater for cases than controls for R1 (14.0±2.3 cm vs 12.9±3.7 cm, p=.02) and R2 (14.2±2.2 cm vs 13.2±3.6 cm, p=.04). In multivariable regression model using pooled reader data, bronchial wall thickening exhibited odds ratio (OR) of 4.6 (95% CI: 1.3, 16.5; p=.02); pericardial effusion, OR 5.1 (95% CI: 1.7, 15.5; p=.004); pulmonary artery diameter, OR 1.4 (95% CI: 0.7, 3.0; p=.32); mean lung height, OR 0.8 (95% CI: 0.7, 1.001; p=.05); anteroposterior chest diameter, OR 1.2 (95% CI: 1.013, 1.4; p=.03). Conclusion: CT features are associated with the need for postoperative mechanical ventilation following abdominal or pelvic surgery. Clinical Impact: Many patients undergo thoracic CT before abdominal or pelvic surgery; the CT findings may complement preoperative clinical risk factors.
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Riggs KW, Zafar F, Jacobs ML, Jacobs JP, Thibault D, Guleserian KJ, Chiswell K, Andersen N, Hill KD, Morales DLS, Bryant R, Tweddell JS. Tracheal surgery for airway anomalies associated with increased mortality in pediatric patients undergoing heart surgery: Society of Thoracic Surgeons Database analysis. J Thorac Cardiovasc Surg 2020; 161:1112-1121.e7. [PMID: 33419543 DOI: 10.1016/j.jtcvs.2020.10.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Airway anomalies are common in children with cardiac disease but with an unquantified impact on outcomes. We sought to define the association between airway anomalies and tracheal surgery with cardiac surgery outcomes using the Society of Thoracic Surgery Congenital Heart Surgery Database. METHODS Index cardiac operations in children aged less than 18 years (January 2010 to September 2018) were identified from the Society of Thoracic Surgery Congenital Heart Surgery Database. Patients were divided on the basis of reported diagnosis of an airway anomaly and subdivided on the basis of tracheal lesion and tracheal surgery. Multivariable analysis evaluated associations between airway disease and outcomes controlling for covariates from the Society of Thoracic Surgery Congenital Heart Surgery Database Mortality Risk Model. RESULTS Of 198,674 index cardiovascular operations, 6861 (3.4%) were performed in patients with airway anomalies, including 428 patients (0.2%) who also underwent tracheal operations during the same hospitalization. Patients with airway anomalies underwent more complex cardiac operations (45% vs 36% Society of Thoracic Surgeons/European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality category ≥3 procedures) and had a higher prevalence of preoperative risk factors (73% vs 39%; both P < .001). In multivariable analysis, patients with airway anomalies had increased odds of major morbidity and tracheostomy (P < .001). Operative mortality was also increased in patients with airway anomalies, except those with malacia. Tracheal surgery within the same hospitalization increased the odds of operative mortality (adjusted odds ratio, 3.9; P < .0001), major morbidity (adjusted odds ratio, 3.7; P < .0001), and tracheostomy (adjusted odds ratio, 16.7; P < .0001). CONCLUSIONS Patients undergoing cardiac surgery and tracheal surgery are at significantly higher risk of morbidity and mortality than patients receiving cardiac surgery alone. Most of those with unoperated airway anomalies have higher morbidity and mortality, which makes it an important preoperative consideration.
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Affiliation(s)
- Kyle W Riggs
- Division of Cardiothoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Cardiothoracic Surgery, Northwell Health, Manhasset, NY.
| | - Farhan Zafar
- Division of Cardiothoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marshall L Jacobs
- Department of Cardiothoracic Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | | | | | - Kristine J Guleserian
- Division of Cardiothoracic Surgery, Department of Surgery, Nicklaus Children's Hospital, Miami, Fla
| | | | - Nick Andersen
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC
| | - Kevin D Hill
- Duke Clinical Research Institute, Durham, NC; Duke Children's Pediatric and Congenital Heart Center, Durham, NC
| | - David L S Morales
- Division of Cardiothoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roosevelt Bryant
- Division of Cardiothoracic Surgery, Department of Surgery, Phoenix Children's Hospital, Phoenix, Ariz
| | - James S Tweddell
- Division of Cardiothoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey. Cardiol Young 2020; 30:1109-1117. [PMID: 32631466 DOI: 10.1017/s104795112000164x] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey. METHODS A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as "Cardiovascular", "Respiratory", "Feeding", "Sedation", "Systems Issue", or "Other" for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018. MEASUREMENTS AND RESULTS Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. "Cardiovascular" (61%) and "Respiratory" (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to "Cardiovascular" and "Respiratory", operations with significantly reduced odds of having "Cardiovascular" Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of "Cardiovascular" Final ICU Need (p < 0.001). "Cardiovascular" and "Respiratory" Final ICU Needs were also associated with provider and ICU discharge season. CONCLUSIONS Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.
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Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future? PLoS One 2020; 15:e0236377. [PMID: 32702064 PMCID: PMC7377469 DOI: 10.1371/journal.pone.0236377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Pro-atrial natriuretic peptide (proANP) and pro-adrenomedullin (proADM) levels increase in acute heart failure and sepsis. After cardiac surgery, children may require increased support in the intensive care unit and may develop complications. The aim of this study was to evaluate the utility of proANP and proADM values, determined prior to cardiac surgery, for predicting the need for increased respiratory or inotropic support during the post-operative period. METHODS This was a prospective study in children. Biomarkers were analyzed before surgery using a single blood test. The primary endpoints were the need for greater respiratory and/or inotropic support during the post-operative period. Secondary endpoints were the relationship between these biomarkers and complications after surgery. RESULTS One hundred thirteen patients were included. ProANP and proADM were higher in children who required greater respiratory and inotropic support, especially proANP; for increased respiratory support, 578.9 vs. 106.6 pmol/L (p = 0.004), and for increased inotropic support, 1938 vs. 110.4 pmol/L (p = 0.002). ProANP had a greater AUC than proADM for predicting increased respiratory support after surgery: 0.791 vs. 0.724. A possible cut-off point for proANP could be ≥ 325 pmol/L (sensitivity = 66.7% and specificity = 88.8%). In the multivariate analysis, the logarithmic transformation of proANP was independently associated with the need for increased respiratory support (OR = 3.575). Patients who presented a poor outcome after cardiac surgery also had higher biomarker values (proADM, p = 0.013; proANP, p = 0.001). CONCLUSIONS Elevated proANP before cardiac surgery may identify which children will need more respiratory and inotropic support during the post-operative period.
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Alsuhaymi ZS, Shihata MS, Alsuhimi SS, Alharbi HB, Khoshal SQ, Syed AU. Outcome of congenital heart surgery for patients with Down Syndrome. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lu C, Wei J, Cai B, Liang J, Wang S. Etiology and Risk Factors for Extubation Failure in Low Birth Weight Infants Undergoing Congenital Heart Surgery. J Cardiothorac Vasc Anesth 2020; 34:3361-3366. [PMID: 32249073 DOI: 10.1053/j.jvca.2020.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the etiology and risk factors of extubation failure (ExF) in low birth weight (LBW) infants undergoing congenital heart surgery. DESIGN Retrospective, comparative study. SETTING A Cantonese cardiac center in China. PARTICIPANTS The cases of all LBW infants undergoing congenital heart surgery admitted to the authors' neonatal intensive care unit from January 2010 to September 2018 were reviewed retrospectively. ExF was defined as reintubation within 72 hours after extubation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic, preoperative, perioperative, and postoperative data were collected. The exclusion criteria were surgical ligation of patent ductus arteriosus and no extubation attempt. Risk factors for ExF were analyzed with univariate and multivariate logistic regression analysis. Ninety-nine infants met the inclusion criteria; the study comprised 66 males and 33 females, including 60 premature infants. ExF occurred in 16 of 99 infants for various kinds of reasons. Infants with ExF had longer postoperative intensive care unit length of stay (LOS) (p < 0.001) and total hospital LOS (p = 0.022). The multivariate logistic regression analysis identified preoperative mechanical ventilation (odds ratio 9.3; 95% confidence interval 1.11-79.52; p = 0.040) and prolonged mechanical ventilation before the first attempted extubation (odds ratio 6.48; 95% confidence interval 1.20-35.17; p = 0.030) as risk factors for ExF. CONCLUSIONS The prevalence of ExF is very high in LBW infants undergoing congenital cardiac surgery. ExF in LBW infants is associated with an increase in hospital LOS. Presumed reasons for failed extubation are diverse. Preoperative mechanical ventilation and prolonged mechanical ventilation before the first attempted extubation were independent risk factors for ExF.
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Affiliation(s)
- Chao Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Cai
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiexian Liang
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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RACHS-1 score as predictive factor for postoperative ventilation time in children with congenital heart disease. Cardiol Young 2020; 30:213-218. [PMID: 31948508 DOI: 10.1017/s1047951120000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital heart disease is the most frequent malformation in newborns. The postoperative mortality of these patients can be assessed with the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score. This study evaluates whether the RACHS-1 score can also be used as a predictor for the length of postoperative ventilation and what is the influence of age. MATERIAL AND METHODS In a retrospective study over the period from 2007 to 2013, all patient records were evaluated: 598 children with congenital heart disease and cardiac surgery were identified and 39 patients have been excluded because of additional comorbidities. For evaluation of mortality, 559 patients could be analysed, after exclusion of 39 deceased patients, 520 cases remained for analysis of postoperative ventilation. RESULTS Overall mortality was 7% with a dependency on RACHS-1 categories. The median length of postoperative ventilation rose according to the RACHS-1 categories: RACHS-1 category 1: 9 hours (interquartile range (IQR) 7-13 hours), category 2: 30 hours (IQR 12-85 hours), category 4: 58 hours (IQR 13-135 hours), category 4: 71 hours (IQR 29-165 hours), and category 6: 189 hours (IQR 127-277 hours). Some of the RACHS-1 subgroups differed significantly from the categories, especially the repair of tetralogy of Fallot with a longer ventilation time and strong variability. Younger age was an independent factor for longer postoperative ventilation. CONCLUSION RACHS-1 is a good predictor for the length of postoperative ventilation after cardiac surgery with the exception of some subgroups. Younger age is another independent factor for longer postoperative ventilation. These data provide better insight into ventilation times and allow better planning of operations in terms of available intensive care beds.
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Wang H, Luo Q, Li Y, Zhang L, Wu X, Yan F. Effect of Prophylactic Levosimendan on All-Cause Mortality in Pediatric Patients Undergoing Cardiac Surgery-An Updated Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:456. [PMID: 32923414 PMCID: PMC7456871 DOI: 10.3389/fped.2020.00456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Levosimendan, a calcium sensitizer, enhances the myocardial function by generating more energy-efficient myocardial contractility than that achieved through adrenergic stimulation with catecholamines. We conducted this meta-analysis to primarily investigate the effects of levosimendan on all-cause mortality in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass. Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till 21st March 2020. The eligible criteria were participants with age<18 year and undergoing cardiac surgery for congenital heart disease (CHD), and studies of comparison between levosimendan and placebo or other inotropes. Stata version 12.0 was used to perform statistical analyses. Results: Six randomized controlled trials (RCTs) and 1 case-control trial (CCT) including 436 patients were included. The results showed that levosimendan did not significantly decrease all-cause mortality compared with control drugs (and placebo) in children undergoing cardiac surgery (P = 0.403). Perioperative prophylactic levosimendan administration strikingly decreased the low cardiac output syndrome (LCOS) incidence (P = 0.016) but did not significantly reduce acute kidney injury (AKI) incidence (P = 0.251) and shorten mechanical ventilation and ICU stay time compared with other inotropes and placebo by analyzing the included literatures [mechanical ventilation (or intubation) time: P = 0.188; ICU stay time: P = 0.620]. Conclusions: Compared with other inotropes and placebo, perioperative prophylactic administration of levosimendan did not decrease the rates of mortality and AKI and shorten the time of mechanical ventilation (or intubation) and ICU stay but demonstrated a significant reduction in LCOS incidence after corrective surgery in pediatric patients for CHD. Due to limited number of included studies, the current data were insufficient to make the conclusions.
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Affiliation(s)
- Hongbai Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qipeng Luo
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinan Li
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhang
- Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Xie Wu
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fuxia Yan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Bobillo-Perez S, Sanchez-de-Toledo J, Segura S, Girona-Alarcon M, Mele M, Sole-Ribalta A, Cañizo Vazquez D, Jordan I, Cambra FJ. Risk stratification models for congenital heart surgery in children: Comparative single-center study. CONGENIT HEART DIS 2019; 14:1066-1077. [PMID: 31545015 DOI: 10.1111/chd.12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Three scores have been proposed to stratify the risk of mortality for each cardiac surgical procedure: The RACHS-1, the Aristotle Basic Complexity (ABC), and the STS-EACTS complexity scoring model. The aim was to compare the ability to predict mortality and morbidity of the three scores applied to a specific population. DESIGN Retrospective, descriptive study. SETTING Pediatric and neonatal intensive care units in a referral hospital. PATIENTS Children under 18 years admitted to the intensive care unit after surgery. INTERVENTIONS None. OUTCOME MEASURES Demographic, clinical, and surgical data were assessed. Morbidity was considered as prolonged length of stay (LOS > 75 percentile), high respiratory (>72 hours of mechanical ventilation), and high hemodynamic support (inotropic support >20). RESULTS One thousand and thirty-seven patients were included, in which 205 were newborns (18%). The category 2 was the most frequent in the three scores: In RACHS-1, ABC, 44.9%, and STS-EACTS, 40.8%. Newborns presented significant higher categories. Children required cardiopulmonary bypass in more occasions (P < .001) but the times of bypass and aortic cross-clamp were significantly higher in newborns (P < .001 and P = .016). Thirty-two patients died (2.8%). A quarter of patients had a prolonged LOS, 17%, a high respiratory support, and 7.1%, a high hemodynamic support. RACHS-1 (AUC 0.760) and STS-EACTS (AUC 0.763) were more powerful for predicting mortality and STS-EACTS for predicting prolonged LOS (AUC 0.733) and the need for high respiratory support (AUC 0.742). CONCLUSIONS STS-EACTS seems to stratify better risk of mortality, prolonged LOS, and need for respiratory support after surgery.
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Affiliation(s)
- Sara Bobillo-Perez
- Disorders of Immunity and Respiration of the Pediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Pediatric Cardiology Department, Hospital Sant Joan de Déu, University of Barcelona, Spain.,Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susana Segura
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Monica Girona-Alarcon
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Maria Mele
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Sole-Ribalta
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Debora Cañizo Vazquez
- Neonatal Intensive Care Unit, Maternal, Fetal and Neonatology Center Barcelona (BCNatal), Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.,Pediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
| | - Francisco Jose Cambra
- Disorders of Immunity and Respiration of the Pediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
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Alrddadi SM, Morsy MM, Albakri JK, Mohammed MA, Alnajjar GA, Fawaz MM, Alharbi AA, Alnajjar AA, Almutairi MM, Sayed AU, Khoshal SQ, Shihata MS, Salim SS, Almuhaya MA, Jelly AE, Alharbi KM, Alharbi IH, Abutaleb AR, Sandogji HI, Hussein MA. Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center. Saudi Med J 2019; 40:367-371. [PMID: 30957130 PMCID: PMC6506664 DOI: 10.15537/smj.2019.4.23682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We studied these predictors at a single cardiac center. Methods: A retrospective cohort study was carried out after obtaining approval from the institutional review board. All patients (age, 0-14 years) who underwent congenital heart disease (CHD) surgery from January 2014 to June 2016 were included. Prolonged mechanical ventilation (PMV) was defined as greater than 72 hours of ventilation. Results: A total of 257 patients were included, among whom 219 (85.2%) were intubated for greater than 72 hours and 38 (14.8%) were intubated for ≥72 hours. Age (29.9 versus 11.95 years), weight (9.6 versus 5.9 kg), cross-clamp time (CCT) (53.6 versus 71.8 min), cardiopulmonary bypass time (CBP) (80.98 versus 124.36 min), length of stay in the pediatric intensive care unit (PICU) (10.4 versus 27.2 days), infection (12.8% versus 42.1%), open sternum (0.9% versus 13.2%), re-intubation (19.2% versus 39.5%), pulmonary hypertension (10.9% versus 31.6%), and impaired heart function (10.1% versus 23.7%) were associated with PMV. In terms of Risk Adjustment in Congenital Heart Surgery (RACHS) classification, only patients with RACHS 4 (18.4%) were associated with the risk for PMV. Conclusions: Age, weight, CBP, CCT, pulmonary hypertension, impaired cardiac function, and sepsis are risk factors for PMV. These factors should be considered when deciding surgery and in providing PICU care.
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Affiliation(s)
- Sulaiman M Alrddadi
- College of Medicine, Department of Pediatrics Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia. E-mail.
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Zhang C, Luo Q, Li Y, Wu X, Hao Z, Li S, Xia Z, Yan F, Sun L. Predictors of Short-term Outcomes Following Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in Chinese Children: A Case-Control Study. J Cardiothorac Vasc Anesth 2018; 32:2644-2651. [DOI: 10.1053/j.jvca.2018.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/11/2022]
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25
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Risk factors and outcomes of tracheostomy after prolonged mechanical ventilation in pediatric patients with heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Incidence and causes of prolonged mechanical ventilation in children with Down syndrome undergoing cardiac surgery. J Saudi Heart Assoc 2018; 30:247-253. [PMID: 29983499 PMCID: PMC6026390 DOI: 10.1016/j.jsha.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Trisomy 21 is the most common syndrome in children with a 30-50% association with congenital heart disease (CHD). Cardiac surgeries are required in the majority of Down syndrome (DS) with CHD cases. Because of the distinctive abnormalities in their respiratory system, children with DS may require longer positive pressure ventilation after cardiac surgery. The aim of this study is to investigate the incidence and possible risk factors for prolonged mechanical ventilation (PMV) need in DS patients undergoing cardiac surgery. Methods We conducted a prospective study on all DS children who underwent cardiac surgery from 2013 to 2016. Demographic and perioperative data were collected including the duration of mechanical ventilation, respiratory risk factors such as previous infection, evidence of pulmonary hypertension during the intensive care unit (ICU) stay, the presence of lung collapse, secretion and wheezy chest, inotropes score, sedation score, arrhythmias, and low cardiac output syndrome. Based on the duration of mechanical ventilation, cases were divided into two groups: the control group, comprising of children who required mechanical ventilation for less than 72 hours, and the PMV group, which consisted of children who required mechanical ventilation for 72 hours or more. Risk factors were compared and analyzed between both groups. Results A total of 102 participants fulfilled the inclusion criteria, 90 of whom were assigned to the control group and 12 to the PMV group (11.7%). Compared with the control group, the PMV group had a higher incidence of pulmonary hypertension at a younger age (83% vs. 23%, p = 0.012) and 50% of them required chronic treatment for pulmonary hypertension upon home discharge. Pneumonia during ICU stay was encountered more frequently in the PMV group (33.3% vs. 2.2%, p = 0.0042). In addition, the PMV group had more frequent signs of low cardiac output syndrome after surgery (25% vs. 2.2%, p = 0.019), longer ICU stays (7 ± 0.3 days vs. 15.6 ± 2.1 days, p = 0.0001), needed more days of inotropes infusion (7.5 ± 0.4 days vs. 11.1 ± 1.6 days, p = 0.0045), and required more sedative and paralytic agents postoperatively (6 ± 0.6 days vs. 8.7 ± 1 days, p = 0.022). Conclusion Overall, 11.7% of DS patients required prolonged ventilation after cardiac surgery. Pulmonary hypertension was seen more frequently in cases requiring PMV, and half of PMV cases required antipulmonary hypertension medication upon discharge. Early recognition of pulmonary hypertension and proper perioperative management are recommended to avoid serious complication and comorbidity after cardiac surgery.
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Mahan VL, Gupta M, Aronoff S, Bruni D, Stevens RM, Moulick A. Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/wjcs.2018.81002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors. J Racial Ethn Health Disparities 2017; 5:410-421. [PMID: 28849382 DOI: 10.1007/s40615-017-0384-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes. STUDY DESIGN This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications. RESULTS Compared to others, black children underwent their first echocardiogram at a later age (median 23 versus 2 days, p = 0.014) and were more likely to be diagnosed with congenital heart disease in the emergency room (p = 0.026). Hispanic children were more likely to have major non-cardiac congenital anomalies (p = 0.045). Increased LOS during elective admissions was associated with higher surgical complexity (STAT category 4 and 5 Estimate 3.905 days, p = 0.001), compared to STAT category 1, and number of complications (Estimate = 2.306 days per complication, p < 0.001). Increased LOS in non-elective admissions was associated with the number of complex chronic conditions (Estimate = 15.446 days, p = 0.045) and the number of complications (Estimate = 11.591 days per complication, p < 0.001). However, in multivariate analysis, race and ethnicity was not associated with increased LOS or age at first echocardiogram. CONCLUSION In this diverse setting, race/ethnicity was not associated with increased LOS, age at first echocardiogram, length of ventilation, or complications. Surgical complexity, chronic conditions, and complications were associated with increased LOS. We discuss some interventions to reduce disparities in congenital heart surgery outcomes.
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