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A simple-to-use nomogram for predicting prolonged mechanical ventilation for children after Ebstein anomaly
Qiao Liu1, Qipeng Luo2, Yinan Li1
1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Insights
A new nomogram helps predict prolonged mechanical ventilation (PMV) risk in children with Ebstein anomaly (EA) after surgery. This tool identifies high-risk patients early, aiding in better management and outcomes for pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Critical Care Medicine
Background:
- Prolonged mechanical ventilation (PMV) following pediatric cardiac surgery significantly increases morbidity, mortality, and healthcare costs.
- Ebstein anomaly (EA) is a rare congenital heart defect, with limited research on PMV risk factors in affected children.
- Early identification of children at risk for PMV is crucial for optimizing postoperative care and resource allocation.
Purpose of the Study:
- To develop a simple, user-friendly nomogram for predicting the risk of prolonged mechanical ventilation (PMV) in pediatric patients with Ebstein anomaly (EA).
- To identify key independent risk factors associated with PMV in children undergoing corrective surgery for EA.
Main Methods:
- A retrospective study analyzed data from 217 children under 18 who underwent corrective surgery for EA between January 2009 and November 2021.
- Prolonged mechanical ventilation (PMV) was defined as mechanical ventilation lasting longer than 24 hours post-surgery.
- Multivariable logistic regression identified risk factors; a nomogram was developed and internally validated using bootstrapping, with calibration and discrimination assessed via ROC curves and the Hosmer-Lemeshow test.
Main Results:
- Of the 217 patients, 44 (20.3%) experienced PMV.
- Five independent risk factors for PMV were identified: preoperative blood oxygen saturation, cardiothoracic ratio, Carpentier type, cardiopulmonary bypass time, and postoperative central venous pressure.
- The developed nomogram demonstrated good discriminative ability, with an area under the ROC curve of 0.805, indicating its potential utility in risk stratification.
Conclusions:
- A practical nomogram integrating five independent risk factors has been developed to predict PMV risk in children with EA.
- This tool facilitates early identification of high-risk pediatric patients, enabling timely intervention and improved postoperative management after EA corrective surgery.
Background:
Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children.
Methods:
The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve.
Results:
Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05.
Conclusions:
We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery.
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