Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery.

Autor:	Goldsmith MP; Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA., Nadkarni VM; Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA., Futterman C; Division of Cardiac Critical Care Medicine, George Washington University, Children's National Medical Center, Washington, DC., Gazit AZ; Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Washington University School of Medicine, Saint Louis Children's Hospital, St. Louis, MO., Baronov D; Etiometry, Inc, Boston, MA., Tomczak A; Etiometry, Inc, Boston, MA., Laussen PC; Department of Cardiology, Division of Cardiovascular Critical Care Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA., Salvin JW; Department of Cardiology, Division of Cardiovascular Critical Care Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2021 Oct 28; Vol. 3 (11), pp. e0563. Date of Electronic Publication: 2021 Oct 28 (Print Publication: 2021).
DOI:	10.1097/CCE.0000000000000563
Abstrakt:	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 (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007). Conclusions: During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients. Competing Interests: Drs. Goldsmith, Nadkarni, Futterman, Gazit, and Salvin are co-investigators (subcontract) on the National Institutes of Health (NIH) Small Business Innovation Research (SBIR) Grant: Risk Assessment Using Noninvasive Measurements in Postoperative Pediatric Patients (NIH; National Heart, Lung, and Blood Institute; and SBIR program [2R44HL117340-03A1/04/05]). Dr. Baronov is one of the founders and the Chief Technology Officer of Etiometry, the company that created the inadequate delivery of oxygen index. He was heavily involved in the index’s development and also owns shares in the company. Dr. Tomczak is an employee of Etiometry. He was heavily involved in the index’s development and also owns shares in the company. Dr. Laussen is a lead developer of the T3 platform, which is owned by Boston Children’s Hospital, Boston, MA, and licensed to Etiometry, Boston, MA; he has received royalties from Boston Children’s Hospital following deployment of the T3 platform; he serves an advisor to Etiometry, for which he has received options in the company; and he is the co-developer of the Inadequate Oxygen Index displayed on the T3 platform. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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