VASOACTIVE INOTROPIC SCORE (VIS) IS ASSOCIATED WITH OUTCOME AFTER INFANT CARDIAC SURGERY: A REPORT OF THE PEDIATRIC CARDIAC CRITICAL CARE CONSORTIUM (PC4)

Abstract Veno-arterial CO2 difference has been considered as a marker of low cardiac output. This study aimed to evaluate the correlation between veno-arterial CO2 difference and cardiac index estimated by MostCareTM in children after cardiac surgery and its association with other indirect perfusion parameters and the complex clinical course (vasoactive inotropic score above 15 or length of stay above 5 days). Data from 40 patients and 127 arterial and venous CO2 measurements for gap calculation taken 0–5 days postoperatively were available. The median (range) veno-arterial CO2 difference value was 9 (1–25 mmHg). The correlation between veno-arterial CO2 difference and cardiac index was not significant (r: −0.16, p = 0.08). However, there was a significant correlation between veno-arterial CO2 difference and vasoactive inotropic score (r: 0.21, p = 0.02), systolic arterial pressure (r: −0.43, p = 0.0001), dP/dtMAX (r: 0.26, p = 0.004), and arterio-venous O2 difference (r: 0.63, p = 0.0001). Systolic arterial pressure (OR 0.95, 95% CI 0.90–0.99), dP/dtMAX (OR 0.00, 95% CI 0.00–0.06), lactates (OR 1.87, 95% CI 1.21–3.31), and veno-arterial CO2 difference (OR 1.13, 95% CI 1.01–1.35) showed a significant univariate association with the complex clinical course. In conclusion, veno-arterial CO2 difference did not correlate with cardiac index estimated by MostCareTM in our cohort of post-cardiosurgical children, but it identified patients with the complex clinical course, especially when combined with other direct and indirect variables of perfusion.

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Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Cardiology in the Young ◽

10.1017/s1047951119000210 ◽

2019 ◽

Vol 29 (4) ◽

pp. 511-518 ◽

Cited By ~ 3

Author(s):

Katja M. Gist ◽

Joshua J. Blinder ◽

David Bailly ◽

Santiago Borasino ◽

David J. Askenazi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Cardiac Surgery ◽

Kidney Injury ◽

Multi Centre Study ◽

Renal Outcomes ◽

Stage 1 ◽

The Impact ◽

Neonatal Kidney ◽

Cardiac Critical Care

AbstractBackground:Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.Methods:The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.Results:A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).Conclusions:Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.

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Predictive Value of Vasoactive-inotropic Score for Mortality in Newborns Undergoing Cardiac Surgery

Indian Pediatrics ◽

10.1007/s13312-019-1639-7 ◽

2019 ◽

Vol 56 (9) ◽

pp. 735-740

Author(s):

Dilek Dilli ◽

Hasan Akduman ◽

Utku Arman Orun ◽

Mehmet Tasar ◽

Irfan Tasoglu ◽

...

Keyword(s):

Cardiac Surgery ◽

Predictive Value ◽

Inotropic Score ◽

Vasoactive Inotropic Score

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Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery

British Journal of Anaesthesia ◽

10.1016/j.bja.2018.12.019 ◽

2019 ◽

Vol 122 (4) ◽

pp. 428-436 ◽

Cited By ~ 20

Author(s):

Timo Koponen ◽

Johanna Karttunen ◽

Tadeusz Musialowicz ◽

Laura Pietiläinen ◽

Ari Uusaro ◽

...

Keyword(s):

Cardiac Surgery ◽

Morbidity And Mortality ◽

Inotropic Score ◽

Vasoactive Inotropic Score

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Comparison of Maximum Vasoactive Inotropic Score and Low Cardiac Output Syndrome As Markers of Early Postoperative Outcomes After Neonatal Cardiac Surgery

Pediatric Cardiology ◽

10.1007/s00246-012-0193-z ◽

2012 ◽

Vol 33 (4) ◽

pp. 633-638 ◽

Cited By ~ 44

Author(s):

Ryan J. Butts ◽

Mark A. Scheurer ◽

Andrew M. Atz ◽

Sinai C. Zyblewski ◽

Thomas C. Hulsey ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Postoperative Outcomes ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Inotropic Score ◽

Neonatal Cardiac Surgery ◽

Vasoactive Inotropic Score

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Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.07.020 ◽

2013 ◽

Vol 146 (2) ◽

pp. 296-301 ◽

Cited By ~ 19

Author(s):

Huy V. Nguyen ◽

Vinod Havalad ◽

Linda Aponte-Patel ◽

Alexandra Y. Murata ◽

Daniel Y. Wang ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Randomized Clinical Trial ◽

Biventricular Pacing ◽

Inotropic Score ◽

Vasoactive Inotropic Score

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Clinical epidemiology and centre variation in chylothorax rates after cardiac surgery in children: a report from the Pediatric Cardiac Critical Care Consortium

Cardiology in the Young ◽

10.1017/s104795111700097x ◽

2017 ◽

Vol 27 (9) ◽

pp. 1678-1685 ◽

Cited By ~ 10

Author(s):

Jason R. Buckley ◽

Eric M. Graham ◽

Michael Gaies ◽

Jeffrey A. Alten ◽

David S. Cooper ◽

...

Keyword(s):

Risk Factors ◽

Critical Care ◽

Cardiac Surgery ◽

Clinical Epidemiology ◽

Central Venous Line ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Linear Regression Models ◽

Significant Morbidity ◽

Cardiac Critical Care

AbstractIntroductionChylothorax after paediatric cardiac surgery incurs significant morbidity; however, a detailed understanding that does not rely on single-centre or administrative data is lacking. We described the present clinical epidemiology of postoperative chylothorax and evaluated variation in rates among centres with a multicentre cohort of patients treated in cardiac ICU.MethodsThis was a retrospective cohort study using prospectively collected clinical data from the Pediatric Cardiac Critical Care Consortium registry. All postoperative paediatric cardiac surgical patients admitted from October, 2013 to September, 2015 were included. Risk factors for chylothorax and association with outcomes were evaluated using multivariable logistic or linear regression models, as appropriate, accounting for within-centre clustering using generalised estimating equations.ResultsA total of 4864 surgical hospitalisations from 15 centres were included. Chylothorax occurred in 3.8% (n=185) of hospitalisations. Case-mix-adjusted chylothorax rates varied from 1.5 to 7.6% and were not associated with centre volume. Independent risk factors for chylothorax included age <1 year, non-Caucasian race, single-ventricle physiology, extracardiac anomalies, longer cardiopulmonary bypass time, and thrombosis associated with an upper-extremity central venous line (all p<0.05). Chylothorax was associated with significantly longer duration of postoperative mechanical ventilation, cardiac ICU and hospital length of stay, and higher in-hospital mortality (all p<0.001).ConclusionsChylothorax after cardiac surgery in children is associated with significant morbidity and mortality. A five-fold variation in chylothorax rates was observed across centres. Future investigations should identify centres most adept at preventing and managing chylothorax and disseminate best practices.

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Noteworthy Literature Published in 2016 for Cardiothoracic Critical Care

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253216687859 ◽

2017 ◽

Vol 21 (1) ◽

pp. 23-29 ◽

Cited By ~ 1

Author(s):

Adam S. Evans ◽

Michael Mazzeffi ◽

Natalia Ivascu ◽

Edward Noguera ◽

Jacob Gutsche

Keyword(s):

Atrial Fibrillation ◽

Critical Care ◽

Cardiac Surgery ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Operating Rooms ◽

Postoperative Atrial Fibrillation ◽

Annual Series ◽

Cardiac Critical Care

In 2016, demand for the presence of cardiothoracic anesthesiologists outside of the cardiac operating rooms continues to expand. This article is the second in this annual series to review relevant contributions in postoperative cardiac critical care that may impact the cardiac anesthesiologist. We explore the use of extracorporeal membrane oxygenation (ECMO), management of postoperative atrial fibrillation, coagulopathy, respiratory failure, and role of quality in cardiac surgery.

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