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Liu J, Zhang Y, Zhang W, Hu J, Peng P, Zhou S, Huang J, Peng J. Prediction of Vasoactive-Inotropic Score on Prolonged Mechanical Ventilation in Adult Congenital Heart Disease Patients After Surgical Treatment Combined with Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2024; 39:e20230218. [PMID: 38748809 PMCID: PMC11099993 DOI: 10.21470/1678-9741-2023-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/20/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION This study aimed to investigate the predictive value of the vasoactive-inotropic score (VIS) at different time points for postoperative prolonged mechanical ventilation (PMV) in adult congenital heart disease patients undergoing surgical treatment combined with coronary artery bypass grafting. METHODS Patients were divided into two groups that developed PMV or not. The propensity score matching method was applied to reduce the effects of confounding factors between the two groups. VIS at different time points (VIS at the end of surgery, VIS6h, VIS12h, and VIS12h max) after surgery were recorded and calculated. The value of VIS in predicting PMV was analyzed by the receiver operating characteristic (ROC) curve, and multivariate logistic regression was used to analyze independent risk factors. RESULTS Among 250 patients, 52 were in the PMV group, and 198 were in the non-PMV group. PMV rate was 20.8%. After propensity score matching, 94 patients were matched in pairs. At each time point, the area under the ROC curve predicted by VIS for PMV was > 0.500, among which VIS at the end of surgery was the largest (0.805). The optimal cutoff point for VIS of 6.5 could predict PMV with 78.7% sensitivity and 72.3% specificity. VIS at the end of surgery was an independent risk factor for PMV (odds ratio=1.301, 95% confidence interval 1.091~1.551, P<0.01). CONCLUSION VIS at the end of surgery is an independent predictor for PMV in patients with adult congenital heart disease surgical treatment combined with coronary artery bypass grafting.
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Affiliation(s)
- Jia Liu
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
| | - Yinghong Zhang
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
| | - Wen Zhang
- Department of Cardiac Surgery, Wuhan Asian Heart Hospital, Wuhan,
People’s Republic of China
| | - Juanzhou Hu
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
| | - Pan Peng
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
| | - Shiqi Zhou
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Huang
- Department of Cardiothoracic Surgery, Wuhan Puren Hospital, Wuhan,
People’s Republic of China
| | - Jiangyun Peng
- Institute of Nursing Research, Hubei Province Key Laboratory of
Occupational Hazard Identification and Control, School of Medicine, Wuhan University
of Science and Technology, Wuhan, People’s Republic of China
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Magoon R. IABP use and outcomes in cardiac valvular surgery: a closer look! Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02029-7. [PMID: 38594583 DOI: 10.1007/s11748-024-02029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Rohan Magoon
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India.
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India.
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Zhao Y, Zhao H, Huang J, Mei B, Xiang J, Wang Y, Lin J, Huang S. Availability and threshold of the vasoactive-inotropic score for predicting early extubation in adults after rheumatic heart valve surgery: a single-center retrospective cohort study. BMC Anesthesiol 2024; 24:102. [PMID: 38500035 PMCID: PMC10946098 DOI: 10.1186/s12871-024-02489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Early extubation (EEx) is defined as the removal of the endotracheal tube within 8 h postoperatively. The present study involved determining the availability and threshold of the vasoactive-inotropic score (VIS) for predicting EEx in adults after elective rheumatic heart valve surgery. METHODS The present study was designed as a single-center retrospective cohort study which was conducted with adults who underwent elective rheumatic heart valve surgery with CPB. The highest VIS in the immediate postoperative period was used in the present study. The primary outcome, the availability of VIS for EEx prediction and the optimal threshold value were determined using ROC curve analysis. The gray zone analysis of the VIS was performed by setting the false negative or positive rate R = 0.05, and the perioperative risk factors for prolonged EEx were identified by multivariate logistic analysis. The postoperative complications and outcomes were compared between different VIS groups. RESULTS Among the 409 patients initially screened, 379 patients were ultimately included in the study. The incidence of EEx was determined to be 112/379 (29.6%). The VIS had a good predictive value for EEx (AUC = 0.864, 95% CI: [0.828, 0.900], P < 0.001). The optimal VIS threshold for EEx prediction was 16.5, with a sensitivity of 71.54% (65.85-76.61%) and a specificity of 88.39% (81.15-93.09%). The upper and lower limits of the gray zone for the VIS were determined as (12, 17.2). The multivariate logistic analysis identified age (OR, 1.060; 95% CI: 1.017-1.106; P = 0.006), EF% (OR, 0.798; 95% CI: 0.742-0.859; P < 0.001), GFR (OR, 0.933; 95% CI: 0.906-0.961; P < 0.001), multiple valves surgery (OR, 4.587; 95% CI: 1.398-15.056; P = 0.012), and VIS > 16.5 (OR, 12.331; 95% CI: 5.015-30.318; P < 0.001) as the independent risk factors for the prolongation of EEx. The VIS ≤ 16.5 group presented a greater success rate for EEx, a shorter invasive ventilation support duration, and a lower incidence of complications than did the VIS > 16.5 group, while the incidence of reintubation was similar between the two groups. CONCLUSION In adults, after elective rheumatic heart valve surgery, the highest VIS in the immediate postoperative period was a good predictive value for EEx, with a threshold of 16.5.
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Affiliation(s)
- Yang Zhao
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of anesthesiology, First Affiliated Hospital of GuangXi Medical University, Nanning, China
| | - Hanlei Zhao
- Department of anesthesiology, Langzhong Hospital of Traditional Chinese Medicine, Langzhong, China
| | - Jiao Huang
- Department of anesthesiology, First Affiliated Hospital of GuangXi Medical University, Nanning, China
| | - Bo Mei
- Department of cardiovascular surgery, Dazhou Central Hospital, Dazhou, China
| | - Jun Xiang
- Department of cardiovascular surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yizheng Wang
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingyan Lin
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - San Huang
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Magoon R. SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023; 27:861-862. [PMID: 37936797 PMCID: PMC10626237 DOI: 10.5005/jp-journals-10071-24524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Magoon R. SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023;27(11):861-862.
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Affiliation(s)
- Rohan Magoon
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Welz F, Schönrath F, Falk V, Just IA. A letter to the editor in response to "Association between vasoactive-inotropic score, morbidity and mortality after heart transplantation". Interdiscip Cardiovasc Thorac Surg 2023:ivad118. [PMID: 37449899 PMCID: PMC10356571 DOI: 10.1093/icvts/ivad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Friedrich Welz
- Deutsches Herzzentrum der Charité. Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany
| | - Felix Schönrath
- Deutsches Herzzentrum der Charité. Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum der Charité. Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Isabell Anna Just
- Deutsches Herzzentrum der Charité. Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Liu C, Li J, Wei Y, Wang Y, Zhang H, Ma L. Preliminary study on the predictive value of the vasoactive-inotropic score for the prognosis of neonatal congenital diaphragmatic hernia. BMC Surg 2023; 23:69. [PMID: 36991393 DOI: 10.1186/s12893-023-01970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND No study has reported on the relationship between the vasoactive-inotropic score (VIS) and the prognosis of neonates with a severe congenital diaphragmatic hernia (CDH). This study aimed to identify potential risk factors for mortality in patients with CDH. We calculated the VIS based on the vasoactive drugs used during the perioperative period to investigate the relationship between VIS and infant prognosis. METHODS We retrospectively analyzed the clinical data of 75 neonates with CDH who were treated at our center between January 2016 and October 2021. We calculated the maximum and mean VIS during the first 24 h of hospitalization (hosVIS [24max] and hosVIS [24mean], respectively) and after surgery (postVIS [24max] and postVIS [24mean], respectively). The relationship between the VIS and the prognosis of neonates with CDH was analyzed using a receiver operating characteristic (ROC) curve, t-test, chi-square test, rank-sum test, and logistic regression analysis. RESULTS In total, 75 participants with CDH were included in the study. The chance of survival was 80%. Our results showed that hosVIS (24max) was an accurate predictor of prognosis (area under the ROC curve = 0.925, p = 0.007). The calculated optimal critical value of hosVIS (24max) for predicting a poor prognosis was 17 (J = 0.75). Multivariate analysis revealed that hosVIS (24max) was an independent risk factor for death in neonates with CDH. CONCLUSION In neonates with CDH, a higher VIS, especially hosVIS (24max), suggests worsened cardiac function, a more severe condition, and a higher risk of death. The rising VIS score in infants prompts physicians to implement more aggressive treatment to improve cardiovascular function.
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Affiliation(s)
- Chao Liu
- Department of Pediatric and Neonatal Surgery, Capital Institute of Pediatrics, Yabao Road #2, 100020, Beijing, China
| | - Jingna Li
- Department of Cardiac Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Yandong Wei
- Department of Pediatric and Neonatal Surgery, Capital Institute of Pediatrics, Yabao Road #2, 100020, Beijing, China
| | - Ying Wang
- Department of Pediatric and Neonatal Surgery, Capital Institute of Pediatrics, Yabao Road #2, 100020, Beijing, China
| | - Hui Zhang
- Department of Cardiac Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Lishuang Ma
- Department of Pediatric and Neonatal Surgery, Capital Institute of Pediatrics, Yabao Road #2, 100020, Beijing, China.
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Hyun J, Kim AR, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Vasoactive-Inotropic Score as a Determinant of Timely Initiation of Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock. Circ J 2021; 86:687-694. [PMID: 34759121 DOI: 10.1253/circj.cj-21-0614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The predictive role of the vasoactive-inotropic score (VIS) for clinical outcomes after venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock is not well known. This study investigated the predictive value of VIS on in-hospital outcomes and the determination of optimal timing for the initiation of VA-ECMO.Methods and Results:Overall, 160 patients with cardiogenic shock requiring VA-ECMO who were treated between December 2012 and August 2018 were analyzed. The in-hospital outcomes according to VIS were compared. Pre-ECMO VIS had an area under the receiver-operating characteristic curve (AUC) of 0.60 (P=0.03) for the prediction of in-hospital death. When the patients were divided into the high (≥32) and low (<32) VIS groups, the high VIS group had a higher rate of in-hospital death (P=0.002) and a lower rate of ECMO weaning (P=0.004). The difference in in-hospital death according to VIS was significant only in patients with a cardiogenic shock of non-ischemic etiology (P=0.01). Extracorporeal cardiopulmonary resuscitation (hazard ratio [HR], 1.99), age (HR, 1.02), pre-ECMO lactate (HR, 1.06), and VIS ≥32 (HR, 2.46) were independently predictive of in-hospital death. CONCLUSIONS Among patients with cardiogenic shock requiring VA-ECMO, the initiation of VA-ECMO before reaching high VIS (≥32) showed better in-hospital outcomes, suggesting that VIS may be a potential marker for determining the initiation of hemodynamic support with VA-ECMO.
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Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Ah-Ram Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Jung Ae Hong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Pil Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
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Gupta V, Kapoor S, Makkar V, Chhabra ST, Aslam N, Mohan B, Kumar R, Pandey V, Prashar H, Kaur G, Grover S, Sethi S, Kaur S, Ralhan S, Wander GS. Managing patients of shock and acute kidney injury in tertiary care cardiac ICU: Experience with continuous renal replacement therapy. Indian Heart J 2021; 73:594-598. [PMID: 34627575 PMCID: PMC8514416 DOI: 10.1016/j.ihj.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/18/2021] [Accepted: 08/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background Clinical experience on details of CRRT initiation and outcomes in cardiac intensive care unit (CICU) patients is not available from developing countries like India. This study shares the 5-year clinical experience of managing CICU patients requiring CRRT in a tertiary care cardiac center of North India. Materials and methods Medical records of all CICU patients with acute kidney injury (AKI) managed by CRRT from October 2011 to September 2016 at tertiary referral center in North India were retrospectively reviewed. Multiple logistic regression analysis was used to identify predictors of post-CRRT mortality. Results A total of 630 patients received CRRT during the study period. Most commonly AKI developed in patients with acute coronary syndrome (30.2 %) with cardiogenic shock. 55.9 % of the CRRT patients were >60 years of age, and/or on multiple supports in ICU including, mechanical ventilation, high doses of inotropes & vasopressors and other cardiovascular support. Of those on CRRT, 130 (20.6 %) patients had died, 215 (34.1 %) were discharged and 285 (45.2 %) could not complete the desired course. Multivariate regression analysis showed independent association of mortality with high vasoactive-inotropic score, single CRRT cycle and low mean arterial pressure in CRRT patients. Conclusion About 34.1 % of patients receiving CRRT were alive at discharge, emphasizing the feasibility and utility of CRRT as a promising modality in this population for improving outcomes.
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Affiliation(s)
- Vivek Gupta
- Department of Cardiac Anaesthesia & Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India.
| | - Samir Kapoor
- Department of Cardiovascular & Thoracic Surgery, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Vikas Makkar
- Department of Nephrology, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | | | - Naved Aslam
- Department of Cardiology, Hero DMC Heart Institute Ludhiana, Punjab, 141001, India
| | - Bishav Mohan
- Department of Cardiology, Hero DMC Heart Institute Ludhiana, Punjab, 141001, India
| | - Rajiv Kumar
- Department of Cardiovascular & Thoracic Surgery, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Vijita Pandey
- Department of Cardiac Anaesthesia & Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Himani Prashar
- Department of Cardiac Anaesthesia & Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Gurkirat Kaur
- Department of Cardiac Anaesthesia & Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Suvir Grover
- Department of Cardiac Anaesthesia & Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - Suman Sethi
- Department of Nephrology, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | - Sarju Ralhan
- Department of Cardiovascular & Thoracic Surgery, Hero DMC Heart Institute, Ludhiana, Punjab, 141001, India
| | - G S Wander
- Department of Cardiology, Hero DMC Heart Institute Ludhiana, Punjab, 141001, India
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Mitaka C, Kusao M, Kawagoe I, Satoh D, Iba T, Ronco C. Impact of Extended Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients with Sepsis: An Observational Study. Blood Purif 2021; 51:62-69. [PMID: 33910191 DOI: 10.1159/000515685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP. METHODS We retrospectively investigated 103 patients with sepsis who underwent PMX-DHP. The demographic data, routine biochemistry, microbiological data, and primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), and PaO2/FiO2, at baseline and day 3, were compared between the standard group (2 h of PMX-DHP) and the extended group (>2 h of PMX-DHP). RESULTS Median MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FiO2 at baseline between the 2 groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FiO2 was significantly larger in the patients who underwent ≥8 h duration than that in patients who underwent <8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups. DISCUSSION/CONCLUSIONS Longer duration of PMX-DHP was associated with the improved MAP and decreased volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP was associated with the improvement in the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock.
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Affiliation(s)
- Chieko Mitaka
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makio Kusao
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Daizoh Satoh
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, International Renal Research Institute (IRRIV), Vicenza, Italy
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Kunigo T, Yoshikawa Y, Yamamoto S, Yamakage M. Preoperative right ventricular dysfunction requires high vasoactive and inotropic support during off-pump coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2021; 69:934-42. [PMID: 33389573 DOI: 10.1007/s11748-020-01557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
Objectives The association of preoperative RV function with hemodynamics during OPCAB or emergency conversion is not clear. The aim of this study was to investigate the association of vasoactive-inotropic score with tricuspid annular plane systolic excursion and tricuspid regurgitation in off-pump coronary artery bypass grafting, and to calculate the optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion to cardiopulmonary bypass. Methods Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between April 2015 and March 2020 were enrolled in this study. We retrospectively assessed the association of intraoperative maximum “vasoactive-inotropic score”, a weighted sum of various inotropes and vasoconstrictors, with tricuspid annular plane systolic excursion and tricuspid regurgitation. A receiver operating characteristic curve of conversion on tricuspid annular plane systolic excursion was also constructed. Results 135 patients were included in final analysis. Conversion was performed in 10 cases. Multiple regression analysis showed that tricuspid annular plane systolic excursion, mild or more tricuspid regurgitation and experienced surgeon were significantly related to vasoactive-inotropic score. The receiver operating characteristic curve to predict conversion by tricuspid annular plane systolic excursion showed an optimal cut-off value of 15.0 mm and area under the curve of 0.808. Conclusions Tricuspid annular plane systolic excursion and tricuspid regurgitation were associated with vasoactive-inotropic score in off-pump coronary artery bypass grafting. The optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion was 15 mm.
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