Academic Journal
Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
| العنوان: | Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery |
|---|---|
| المؤلفون: | Goldsmith, Michael P., Nadkarni, Vinay M., Futterman, Craig, Gazit, Avihu Z., Baronov, Dimitar, Tomczak, Adam, Laussen, Peter C., Salvin, Joshua W. |
| المصدر: | Critical Care Explorations ; volume 3, issue 11, page e0563 ; ISSN 2639-8028 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health) |
| سنة النشر: | 2021 |
| الوصف: | OBJECTIVES: Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. DESIGN: Multicenter retrospective cohort study. SETTING: Three pediatric cardiac ICUs at tertiary academic children’s hospitals. PATIENTS: Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Postoperative patients were identified who successfully weaned off initial vasoactive infusions ( n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) ( n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [ sd 19.0] vs 6.4 [ sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5–6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1097/cce.0000000000000563 |
| DOI: | 10.1097/CCE.0000000000000563 |
| الاتاحة: | http://dx.doi.org/10.1097/cce.0000000000000563 https://journals.lww.com/10.1097/CCE.0000000000000563 |
| Rights: | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| رقم الانضمام: | edsbas.EC4ECE5 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/cce.0000000000000563 |
|---|