Department of Cardiology, Boston Children's Hospital, Boston, MA.
Department of Pediatrics, Harvard Medical School, Boston, MA.
Pediatr Crit Care Med. 2021 Jan 1;22(1):e67-e78. doi: 10.1097/PCC.0000000000002524.
To determine whether shock index, coronary perfusion pressure, or rate pressure product in the first 24 hours after congenital heart surgery are independent predictors of subsequent clinically significant adverse outcomes.
A retrospective cohort study.
A tertiary care center.
All patients less than 18 years old who underwent cardiac surgery at Boston Children's Hospital between January 1, 2010, and December 31, 2018.
None.
Shock index (heart rate/systolic blood pressure), coronary perfusion pressure (diastolic blood pressure-right atrial pressure), and rate pressure product (heart rate × systolic blood pressure) were calculated every 5 seconds, and the median value for the first 24 hours of cardiac ICU admission for each was used as a predictor. The composite, primary outcome was the occurrence of any of the following adverse events in the first 7 days following cardiac ICU admission: cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation, mechanical circulatory support, unplanned surgery, heart transplant, or death. The association of each variable of interest with this outcome was tested in a multivariate logistic regression model. Of the 4,161 patients included, 296 (7%) met the outcome within the specified timeframe. In a multivariate regression model adjusted for age, surgical complexity, inotropic and respiratory support, and organ dysfunction, shock index greater than 1.83 was significantly associated with the primary outcome (odds ratio, 6.6; 95% CI, 4.4-10.0), and coronary perfusion pressure greater than 35 mm Hg was protective against the outcome (odds ratio, 0.5; 0.4-0.7). Rate pressure product was not found to be associated with the outcome. However, the predictive ability of the shock index and coronary perfusion pressure models were not superior to their component hemodynamic variables alone.
Both shock index and coronary perfusion pressure may offer predictive value for adverse outcomes following cardiac surgery in children, although they are not superior to the primary hemodynamic variables.
确定先天性心脏病手术后 24 小时内的休克指数、冠状动脉灌注压或心率血压乘积是否为后续临床显著不良结局的独立预测因素。
回顾性队列研究。
三级护理中心。
2010 年 1 月 1 日至 2018 年 12 月 31 日期间在波士顿儿童医院接受心脏手术的所有年龄小于 18 岁的患者。
无。
每 5 秒计算一次休克指数（心率/收缩压）、冠状动脉灌注压（舒张压-右心房压）和心率血压乘积（心率×收缩压），并将入院心脏重症监护病房的前 24 小时的中位数用作预测值。复合主要结局为心脏重症监护病房入院后 7 天内发生以下任何不良事件：心肺复苏、体外心肺复苏、机械循环支持、计划外手术、心脏移植或死亡。使用多变量逻辑回归模型测试每个感兴趣变量与该结果的关联。在纳入的 4161 例患者中，296 例（7%）在规定的时间范围内达到了该结果。在调整年龄、手术复杂性、正性肌力和呼吸支持以及器官功能障碍的多变量回归模型中，休克指数大于 1.83 与主要结局显著相关（比值比，6.6；95%CI，4.4-10.0），冠状动脉灌注压大于 35mmHg 可预防该结果（比值比，0.5；0.4-0.7）。心率血压乘积与结果无关。然而，休克指数和冠状动脉灌注压模型的预测能力并不优于其单独的主要血流动力学变量。
休克指数和冠状动脉灌注压均可为儿童心脏手术后不良结局提供预测价值，尽管它们并不优于主要血流动力学变量。
