Defining Vasoplegia Following Durable, Continuous Flow Left Ventricular Assist Device Implantation
| Autor: | Arvind Bhimaraj, Wadi N. Suki, Joshua T. Swan, Tomona Iso, Barry H. Trachtenberg, Elsie Rizk, Jill Krisl, Erik E. Suarez, Mahwash Kassi, Adaani E. Frost, Noel Martin Giesecke, Sara Varnado, Faisal Masud, Faisal S Uddin |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Mean arterial pressure medicine.medical_treatment Biomedical Engineering Biophysics Cardiac index Bioengineering law.invention Biomaterials law Internal medicine Vasoplegia medicine Cardiopulmonary bypass Humans Retrospective Studies Cardiopulmonary Bypass Continuous flow business.industry Incidence General Medicine Intensive care unit medicine.anatomical_structure Ventricular assist device Cardiology Vascular resistance Heart-Assist Devices business |
| Zdroj: | ASAIO Journal. |
| ISSN: | 1058-2916 |
| DOI: | 10.1097/mat.0000000000001419 |
| Popis: | This study aimed to develop a definition of vasoplegia that reliably predicts clinical outcomes. Vasoplegia was evaluated using data from the electronic health record for each 15-minute interval for 72 hours following cardiopulmonary bypass. Standardized definitions considered clinical features (systemic vascular resistance [SVR], mean arterial pressure [MAP], cardiac index [CI], norepinephrine equivalents [NEE]), threshold strategy (criteria occurring in any versus all measurements in an interval), and duration (criteria occurring over multiple consecutive versus separated intervals). Minor vasoplegia was MAP 60 mm Hg or SVR 800 dynes⋅sec⋅cm-5 with CI 2.2 L/min/m2 and NEE ≥ 0.1 µg/kg/min. Major vasoplegia was MAP 60 mm Hg or SVR 700 dynes⋅sec⋅cm-5 with CI 2.5 L/min/m2 and NEE ≥ 0.2 µg/kg/min. The primary outcome was incidence of vasoplegia for eight definitions developed utilizing combinations of these criteria. Secondary outcomes were associations between vasoplegia definitions and three clinical outcomes: time to extubation, time to intensive care unit discharge, and nonfavorable discharge. Minor vasoplegia detected anytime within a 15-minute period (MINOR_ANY_15) predicted the highest incidence of vasoplegia (61%) and was associated with two of three clinical outcomes: 1 day delay to first extubation (95% CI: 0.2 to 2) and 7 day delay to first intensive care unit discharge (95% CI: 1 to 13). The MINOR_ANY_15 definition should be externally validated as an optimal definition of vasoplegia. |
| Databáze: | OpenAIRE |
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