Predicting Peri-Operative Cardiorespiratory Adverse Events in Children with Idiopathic Pulmonary Arterial Hypertension Undergoing Cardiac Catheterization Using Echocardiography: A Cohort Study.

Autor: Dawes TJW; Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK. Timothy.Dawes@gosh.nhs.uk.; UCL Institute of Cardiovascular Science, University College London, London, UK. Timothy.Dawes@gosh.nhs.uk., Woodham V; Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK., Sharkey E; Department of Anaesthesia, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK., McEwan A; Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK., Derrick G; UCL Institute of Cardiovascular Science, University College London, London, UK.; Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Muthurangu V; UCL Institute of Cardiovascular Science, University College London, London, UK., Moledina S; UCL Institute of Cardiovascular Science, University College London, London, UK.; National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK., Hepburn L; Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2024 Mar 21. Date of Electronic Publication: 2024 Mar 21.
DOI: 10.1007/s00246-024-03447-3
Abstrakt: General anesthesia in children with idiopathic pulmonary arterial hypertension (PAH) carries an increased risk of peri-operative cardiorespiratory complications though risk stratifying individual children pre-operatively remains difficult. We report the incidence and echocardiographic risk factors for adverse events in children with PAH undergoing general anesthesia for cardiac catheterization. Echocardiographic, hemodynamic, and adverse event data from consecutive PAH patients are reported. A multivariable predictive model was developed from echocardiographic variables identified by Bayesian univariable logistic regression. Model performance was reported by area under the curve for receiver operating characteristics (AUC roc ) and precision/recall (AUC pr ) and a pre-operative scoring system derived (0-100). Ninety-three children underwent 158 cardiac catheterizations with mean age 8.8 ± 4.6 years. Adverse events (n = 42) occurred in 15 patients (16%) during 16 catheterizations (10%) including cardiopulmonary resuscitation (n = 5, 3%), electrocardiographic changes (n = 3, 2%), significant hypotension (n = 2, 1%), stridor (n = 1, 1%), and death (n = 2, 1%). A multivariable model (age, right ventricular dysfunction, and dilatation, pulmonary and tricuspid regurgitation severity, and maximal velocity) was highly predictive of adverse events (AUC roc 0.86, 95% CI 0.75 to 1.00; AUC pr 0.68, 95% CI 0.50 to 0.91; baseline AUC pr 0.10). Pre-operative risk scores were higher in those who had a subsequent adverse event (median 47, IQR 43 to 53) than in those who did not (median 23, IQR 15 to 33). Pre-operative echocardiography informs the risk of peri-operative adverse events and may therefore be useful both for consent and multi-disciplinary care planning.
(© 2024. The Author(s).)
Databáze: MEDLINE
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