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Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery
Pota Abhay1, Rajesh Sharma2, Anil Bhan3
1Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India.
Insights
The vasoactive-ventilation-renal (VVR) score accurately predicts outcomes in pediatric cardiac surgery patients. This score, assessed 48 hours post-operation, correlates with prolonged intensive care unit stays and ventilation durations.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Accurate prediction of postoperative outcomes in pediatric cardiac surgery is crucial.
- Early identification of clinical characteristics is needed to guide management.
Purpose of the Study:
- To evaluate the vasoactive-ventilation-renal (VVR) score's ability to predict outcomes in pediatric cardiac surgery.
- To compare the VVR score with other clinical scores for outcome prediction.
Main Methods:
- A prospective cohort study included 199 children (<18 years) undergoing cardiac surgery for congenital heart disease.
- The vasoactive-ventilation-renal (VVR) score was analyzed at 48 hours postoperation.
- Comparison of VVR score with other clinical scores for predicting length of stay and mechanical ventilation.
Main Results:
- The VVR score at 48 hours showed higher Area Under the Curve (AUC) values compared to other clinical scores for predicting outcomes.
- The VVR score demonstrated strong correlation with prolonged pediatric intensive care unit (PICU) stay (AUC=0.715), length of hospitalization (AUC=0.723), and ventilation duration (AUC=0.843).
Conclusions:
- The 48-hour vasoactive-ventilation-renal (VVR) score is a reliable predictor of prolonged PICU stay, hospitalization, and ventilation in pediatric cardiac surgery patients.
- The VVR score offers valuable insights for early risk stratification and management in this population.
Introduction:
There is a need to index important clinical characteristics in pediatric cardiac surgery that can be obtained early in the postoperative period and accurately predict postoperative outcomes.
Methodology:
A prospective cohort study was conducted in the pediatric cardiac ICU and ward on all children aged <18 years undergoing cardiac surgery for congenital heart disease from September 2018 to October 2020. The vasoactive-ventilation-renal (VVR) score was analyzed to predict outcomes of cardiac surgeries with a comparison of postoperative variables.
Results:
A total of 199 children underwent cardiac surgery during the study period. The median (interquartile range) age was 2 (0.8-5) years, and the median weight was 9.3 (6-16) kg. The most common diagnoses were ventricular septal defect (46.2%) and tetralogy of Fallot (37.2%). At the 48th h, area under the curve (AUC) (95% CI) values were higher for the VVR score than those for other clinical scores measured. Similarly, at the 48th h, AUC (95% CI) values were higher for the VVR score than those for the other clinical scores measured for the length of stay and mechanical ventilation.
Discussion:
The VVR score at 48 h postoperation was found to best correlate with prolonged pediatric intensive care unit (PICU) stay, length of hospitalization, and ventilation duration, with the greatest AUC-receiver operating characteristic (0.715, 0.723, and 0.843, respectively). The 48-h VVR score correlates well with prolonged ICU, hospital stay, and ventilation.
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