Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery.
Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery.
复制标题
心胸外科手术后新生儿和婴儿的血管活性肌力评分及其与短期结果的相关性的前瞻性验证。
DOI：
10.1007/s00134-012-2544-x
复制
发表时间：
2012-07
影响因子：
38.9
通讯作者：
Kaufman J
中科院分区：
文献类型：
--
作者：
Davidson J;Tong S;Hancock H;Hauck A;da Cruz E;Kaufman J
心血管手术后婴儿血管活性变力评分(VIS)和变力评分(IS)的前瞻性验证对70名接受心胸手术的婴儿(≤90天)进行的前瞻性观察研究。术后24小时(VIS24，IS24)、48小时(VIS48，IS48)和72小时(VIS72，IS72)分别进行VIS和IS评定。计算前48小时的最大VIS和IS评分(VIS48max和IS48max)。主要结果是插管时间。其他结果包括重症监护(ICU)住院和住院时间、心脏骤停、死亡率、液体负平衡时间、乳酸峰值和肌酐变化。根据受试者操作特征(ROC)分析，VIS48的曲线下面积(AUC)最高，可识别插管时间延长。在评估的所有时间点，VIS的主要结果的AUC高于IS。多因素分析显示，VIS48与插管时间延长(OR22.3，p=0.002)、ICU住院时间延长(OR8.1，p=0.017)、住院时间延长(OR11.3，p=0.011)独立相关。VIS48max、IS48max和IS48也与插管时间延长有关，但与ICU或住院时间延长无关。所有评分均与液体负平衡时间、乳酸峰值或肌酐变化无关。在新生儿和婴儿中，心胸手术后48小时的高VIS与增加的机械通气量、延长的ICU和总住院时间密切相关。在评估的所有时间点上，VIS比IS更能预测不良的短期结果。VIS作为一个独立的预后预测指标可能是有用的。
Prospective validation of vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) hours after surgery. Maximum VIS and IS scores in the first 48 hours were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine. Based on Receiver Operating Characteristic (ROC) analysis, area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3, p=0.002), prolonged ICU stay (OR 8.1, p=0.017), and prolonged hospitalization (OR 11.3, p=0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine. In neonates and infants, a higher VIS at 48 hours after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short term outcome than IS. VIS may be useful as an independent predictor of outcomes.