Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass
Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass
复制标题
DOI：
10.1097/pcc.0b013e3181b806fc
复制
发表时间：
2010-03-01
影响因子：
4.1
通讯作者：
Hirsch, Jennifer C.
中科院分区：
文献类型：
--
作者：
Gaies, Michael G.;Gurney, James G.;Hirsch, Jennifer C.
目的：正性肌力评分已被提议作为小儿心脏手术后疾病严重程度的标志，尽管缺乏数据支持其使用。本研究的目的是确定婴儿心脏手术后正性肌力/血管活性支持与临床结局之间的关系。设计：回顾性病历回顾。设置：一个学术三级医疗中心的专门儿科心胸重症监护室。患者：一百七十-4名0 - 6个月大的患者在8月12日至14日期间接受心肺转流心脏手术后入住心胸重症监护室，2007年和2008年6月。百分之四十三是新生儿，39%的功能性单心室physiology.Interventions：无测量和主要结果：每小时剂量的所有血管活性药物被记录为入院后的第一个48小时心胸重症监护病房和血管活性，正性肌力评分计算。最初48小时内的最大血管活性-变力性评分水平是不良临床结局（死亡、心脏骤停、机械循环支持、肾脏替代治疗和/或神经损伤）的良好预测因子。在控制诊断后，与最大血管活性-变力性评分较低的患者相比，最大血管活性-变力性评分较高的患者与不良结局密切相关，校正比值比为8.1（95%置信区间，3.4-19.2; p <0.001）。高血管活性变力性评分也与长期心胸重症监护室停留，机械通气的持续时间，负液体balanc.Conclusions时间：在第一个48小时的心血管支持量先天性心脏病手术后，心肺转流预测最终的发病率和死亡率在年幼的婴儿。支持程度最好通过在此期间获得的最大血管活性-变力性评分来表征。血管活性-正性肌力评分作为婴儿心脏手术后临床结局的独立预测因子的有用性可能对未来心胸重症监护病房的研究具有重要意义。（Pediatr Crit Care Med 2010; 11：234-238）
Objective: Inotrope score has been proposed as a marker of illness severity after pediatric cardiac surgery despite a lack of data to support its use as such. The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcome in infants after cardiac surgery.Design: Retrospective chart review.Setting: Dedicated pediatric cardiothoracic intensive care unit at an academic, tertiary care medical center.Patients: One hundred seventy-four patients 0 to 6 months of age admitted to the cardiothoracic intensive care unit after cardiac surgery with cardiopulmonary bypass between August 2007 and June 2008. Forty-three percent were neonates, and 39% had functional single ventricle physiology.Interventions: None.Measurements and Main Results: Hourly doses of all vasoactive medications were recorded for the first 48 hrs after admission to the cardiothoracic intensive care unit and a vasoactive-inotropic score was calculated. The maximum vasoactive-inotropic score level over the first 48 hrs was a good predictor of poor clinical outcome (death, cardiac arrest, mechanical circulatory support, renal replacement therapy, and/or neurologic injury). After controlling for diagnosis, high maximum vasoactive-inotropic score was strongly associated with a poor outcome with an adjusted odds ratio of 8.1 (95% confidence interval, 3.4-19.2; p < .001) compared with patients with a low maximum vasoactive-inotropic score. High vasoactive-inotropic score was also associated with prolonged cardiothoracic intensive care unit stay, duration of mechanical ventilation, and time to negative fluid balance.Conclusions: The amount of cardiovascular support in the first 48 hrs after congenital heart surgery with cardiopulmonary bypass predicts eventual morbidity and mortality in young infants. The degree of support is best characterized by a maximum vasoactive-inotropic score obtained during this period. The usefulness of vasoactive-inotropic score as an independent predictor of clinical outcome in infants after cardiac surgery may have important implications for future cardiothoracic intensive care unit research. (Pediatr Crit Care Med 2010; 11: 234-238)