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A novel nomogram for predicting respiratory adverse events during transport after interventional cardiac
Chaoyang Tong1, Peiwen Liu1, Kan Zhang1
1Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.
Insights
Respiratory adverse events (RAEs) occur in 23.1% of pediatric cardiac catheterization patients during transport. A new nomogram helps predict RAEs, aiding clinicians in developing safer transport plans for children.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Respiratory adverse events (RAEs) during post-operative transport in pediatric cardiac catheterization patients are not well understood.
- Predicting and mitigating these events is crucial for patient safety and optimizing care.
Purpose of the Study:
- To determine the incidence and predictors of RAEs during transport after pediatric cardiac catheterization.
- To develop a predictive nomogram for RAEs in this patient population.
Main Methods:
- A prospective cohort study included 290 pediatric patients undergoing VSD, ASD, or PDA procedures.
- RAEs were defined as composite events including laryngospasm, apnea, and oxygen desaturation.
- A nomogram was developed using independent predictors and internally validated.
Main Results:
- The incidence of RAEs during transport was 23.1%.
- Key predictors identified included age, preoperative upper respiratory tract infections, type of surgery, morphine and atropine use, and RAEs during extubation.
- The developed nomogram demonstrated good predictive accuracy and clinical usefulness.
Conclusions:
- The high rate of RAEs highlights the need for increased vigilance during transport.
- The nomogram provides a reliable tool for identifying high-risk pediatric patients, enabling tailored transport strategies.
- Findings support improved risk prediction, clinical intervention, and healthcare quality control for pediatric cardiac procedures.
Objective:
The rate and predictors of respiratory adverse events (RAEs) during transport discharged from operating room after interventional cardiac catheterization in children remain unclear. This study aimed to investigate the incidence and predictors, and to construct a nomogram for predicting RAEs during transport in this pediatric surgical treatment.
Methods:
This prospective cohort study enrolled 290 consecutive pediatric patients who underwent ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) between February 2019 and December 2020. Independent predictors were used to develop a nomogram, and a bootstrap resampling approach was used to conduct internal validation. Composite RAEs were defined as the occurrence of at least 1 complication regarding laryngospasm, bronchospasm, apnea, severe cough, airway secretions, airway obstruction, and oxygen desaturation.
Results:
The rate of RAEs during transport was 23.1% (67 out of 290). Multivariate analysis identified age (vs. ≤3 years, adjusted odds ratio (aOR) = 0.507, 95% confidence interval (CI), 0.268-0.958, P = 0.036), preoperative upper respiratory tract infections (URI, aOR = 2.335, 95% CI, 1.223-4.460, P = 0.01), type of surgery (vs. VSD, for ASD, aOR = 2.856, 95% CI, 1.272-6.411, P = 0.011; for PDA, aOR = 5.518, 95% CI, 2.425-12.553, P < 0.001), morphine equivalent (vs. ≤0.153 mg/kg, aOR = 2.904, 95% CI, 1.371-6.150, P = 0.005), atropine usage (aOR = 0.463, 95% CI, 0.244-0.879, P = 0.019), and RAEs during extubation to transport (aOR = 5.004, 95% CI, 2.633-9.511, P < 0.001) as independent predictors of RAEs during transport. These six candidate predictors were used to develop a nomogram, which showed a C-statistic value of 0.809 and good calibration (P = 0.844). Internal validation revealed similarly good discrimination (C-statistic, 0.782; 95% CI, 0.726-0.837) and calibration. Decision curve analysis (DCA) also demonstrated the clinical usefulness of the nomogram.
Conclusion:
The high rate of RAEs during transport reminds us of the need for more medical care and attention. The proposed nomogram can reliably identify pediatric patients at high risk of RAEs during transport and guide clinicians to make proper transport plans. Our findings have important and meaningful implications for RAEs risk prediction, clinical intervention and healthcare quality control.
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