Vasoactive inotropic score for predicting tracheostomy in pediatric cardiac surgery patients

Keywords

Intensive care
Pediatric cardiac surgery
Tracheostomy
Vasoactive inotropic score

How to Cite

Silahli, M., Tekin, M. ., & Çelik, M. (2022). Vasoactive inotropic score for predicting tracheostomy in pediatric cardiac surgery patients. Iranian Red Crescent Medical Journal, 24(10). https://doi.org/10.32592/ircmj.2022.24.10.1088

Abstract

Background: Although tracheostomy is not often performed as much as in adults, they are also applied in childhood. There is no clear consensus on timing and risk factors, especially in early infancy and in cases who underwent cardiac surgeries. In the early infancy period, pediatric cardiac surgery patients have to receive an inotropic agent after the cardiac surgery due to poor general condition or hemodynamic instability. As a result of prolonged intubation, tracheostomy is required to be performed in some of these patients.

Objectives: The present study aimed to investigate the relationship between vasoactive inotropic scores (VIS) and tracheostomy in pediatric cardiac surgery patients.

Methods:The VIS and inotrope score (IS) values were calculated and recorded hourly for 48 h postoperatively. Scores were calculated by multiplying the inotropes infusion rate of the patients with certain coefficients. It was attempted to determine objective formalized models and cut-off values that may benefit the relationship between VIS values and tracheostomy.

Results: The median weight was 3,630 g (range, 2,040-13,400), and the median age was 69 days (range, 1-1,081) on the surgery day. The majority (93.6%) of the patients were aged < 1 year. Preoperative C-reactive protein measurements were significantly higher by 50% in patients who underwent tracheostomy (P=0.005). The albumin levels in the tracheostomy group (TG) were low, although not significantly (P=0.057). The VIS values of TG had 50% higher values than the non-tracheostomy group (NTG) (P<0.001). Moreover, formula 1, with 57% accuracy, predicted tracheostomy (VIS=18.170-0.170* HOUR; P<0.001), and formula 2, with 72% accuracy, predicted that tracheostomy could not be performed (VIS=17.170-0.170* HOUR; P<0.001). Hospital stay (P<0.001), mechanical ventilation duration (P<0.001), and the number of ongoing intubation on the 7th day post-surgery were significantly higher in TG.

Conclusion: After pediatric cardiac surgery, VIS values can predict tracheostomy status and help intensive care professionals make decisions.

 

 

 

 

https://doi.org/10.32592/ircmj.2022.24.10.1088

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