Clinical Operational Research Unit, University College London, London, United Kingdom.
Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, United Kingdom.
Pediatr Crit Care Med. 2019 Aug;20(8):737-743. doi: 10.1097/PCC.0000000000001960.
To evaluate the effectiveness of two scoring systems, the inadequate oxygen delivery index, a risk analytics algorithm (Etiometry, Boston, MA) and the Low Cardiac Output Syndrome Score, in predicting adverse events recognized as indicative of low cardiac output syndrome within 72 hours of surgery.
A retrospective observational pair-matched study.
Tertiary pediatric cardiac ICU.
Children undergoing cardiac bypass for congenital heart defects. Cases experienced an adverse event linked to low cardiac output syndrome in the 72 hours following surgery (extracorporeal membrane oxygenation, renal replacement therapy, cardiopulmonary resuscitation, and necrotizing enterocolitis) and were matched with a control patient on criteria of procedure, diagnosis, and age who experienced no such event.
None.
Of a total 536 bypass operations in the study period, 38 patients experienced one of the defined events. Twenty-eight cases were included in the study after removing patients who suffered an event after 72 hours or who had insufficient data. Clinical and laboratory data were collected to derive scores for the first 12 hours after surgery. The inadequate oxygen delivery index was calculated by Etiometry using vital signs and laboratory data. A modified Low Cardiac Output Syndrome Score was calculated from clinical and therapeutic markers. The mean inadequate oxygen delivery and modified Low Cardiac Output Syndrome Score were compared within each matched pair using the Wilcoxon signed-rank test. Inadequate oxygen delivery correctly differentiated adverse events in 13 of 28 matched pairs, with no evidence of inadequate oxygen delivery being higher in cases (p = 0.71). Modified Low Cardiac Output Syndrome Score correctly differentiated adverse events in 23 of 28 matched pairs, with strong evidence of a raised score in low cardiac output syndrome cases (p < 0.01).
Although inadequate oxygen delivery is an Food and Drug Administration approved indicator of risk for low mixed venous oxygen saturation, early postoperative average values were not linked with medium-term adverse events. The indicators included in the modified Low Cardiac Output Syndrome Score had a much stronger association with the specified adverse events.
评估两种评分系统的有效性，即不足氧输送指数（一种风险分析算法，Etiometry，波士顿，马萨诸塞州）和低心输出量综合征评分，以预测手术后 72 小时内被认为是低心输出量综合征的不良事件。
回顾性观察配对研究。
三级儿科心脏重症监护病房。
接受心脏旁路手术治疗先天性心脏病的儿童。病例在手术后 72 小时内经历了与低心输出量综合征相关的不良事件（体外膜氧合、肾脏替代治疗、心肺复苏和坏死性小肠结肠炎），并与在手术、诊断和年龄方面无此类事件的对照患者相匹配。
无。
在研究期间的 536 次旁路手术中，有 38 名患者经历了其中一种定义的事件。在去除了在 72 小时后发生事件或数据不足的患者后，28 例病例被纳入研究。在手术后的头 12 小时内收集了临床和实验室数据以得出评分。不足氧输送指数通过 Etiometry 使用生命体征和实验室数据计算。从临床和治疗标志物中计算出改良低心输出量综合征评分。使用 Wilcoxon 符号秩检验比较每个匹配对中不足氧输送和改良低心输出量综合征评分的平均值。不足氧输送在 28 对匹配对中的 13 对中正确区分了不良事件，且病例中不足氧输送升高的证据不足（p = 0.71）。改良低心输出量综合征评分在 28 对匹配对中的 23 对中正确区分了不良事件，低心输出量综合征病例中评分升高的证据很强（p < 0.01）。
尽管不足氧输送是食品和药物管理局批准的低混合静脉血氧饱和度风险指标，但术后早期平均水平与中期不良事件无关。改良低心输出量综合征评分中包含的指标与指定的不良事件有更强的关联。
