Nicoll Jessica, Somer Jonathan, Eytan Danny, Chau Vann, Marini Davide, Lim Jessie Mei, Greer Robert, Aly Safwat, Seed Mike, Miller Steven P, Laussen Peter C, Mazwi Mjaye L, Schwartz Steven M
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada.
Discipline of Pediatrics, Memorial University, St. John's, NL, Canada.
Crit Care Explor. 2022 Sep 2;4(9):e0751. doi: 10.1097/CCE.0000000000000751. eCollection 2022 Sep.
Continuous data capture technology is becoming more common. Establishing analytic approaches for continuous data could aid in understanding the relationship between physiology and clinical outcomes.
Our objective was to design a retrospective analysis for continuous physiologic measurements and their relationship with new brain injury over time after cardiac surgery.
Retrospective cohort study in the Cardiac Critical Care Unit at the Hospital for Sick Children in patients after repair of transposition of the great arteries (TGA) or single ventricle (SV) lesions.
Continuously acquired physiologic measurements for up to 72 hours after cardiac surgery were analyzed for association with new brain injury by MRI. Distributions of heart rate (HR), systolic blood pressure (BP), and oxygen saturation (Spo) for SV and TGA were analyzed graphically and with descriptive statistics over postoperative time for data-driven variable selection. Mixed-effects regression analyses characterized relationships between HR, BP, and Spo and new brain injury over time while accounting for variation between patients, measurement heterogeneity, and missingness.
Seventy-seven patients (60 TGA; 17 SV) were included. New brain injury was seen in 26 (34%). In SV patients, with and without new brain injury, respectively, in the first 24 hours after cardiac surgery, the median (interquartile range) HR was 172.0 beats/min (bpm) (169.7-176.0 bpm) versus 159.6 bpm (145.0-167.0 bpm); systolic BP 74.8 (67.9-78.5 mm Hg) versus 68.9 mm Hg (61.6-70.9 mm Hg). Higher postoperative HR (parameter estimate, 19.4; 95% CI, 7.8-31; = 0.003 and BP, 8.6; 1.3-15.8; = 0.024) were associated with new brain injury in SV patients. The strength of this relationship decreased with time.
Retrospective analysis of continuous physiologic measurements can provide insight into changes in postoperative physiology over time and their relationship with new brain injury. This technique could be applied to assess relationships between physiologic data and many patient interventions or outcomes.
连续数据捕获技术正变得越来越普遍。建立针对连续数据的分析方法有助于理解生理学与临床结局之间的关系。
我们的目的是设计一项回顾性分析，以研究心脏手术后连续生理测量值及其随时间与新发脑损伤之间的关系。
设计、设置与参与者：对病童医院心脏重症监护病房中接受大动脉转位（TGA）或单心室（SV）病变修复术后的患者进行回顾性队列研究。
分析心脏手术后长达72小时连续获取的生理测量值与MRI检测到的新发脑损伤之间的关联。通过图形分析以及描述性统计分析SV和TGA患者术后不同时间点的心率（HR）、收缩压（BP）和血氧饱和度（Spo）分布情况，以进行数据驱动的变量选择。混合效应回归分析确定了HR、BP和Spo与新发脑损伤随时间的关系，同时考虑了患者之间的差异、测量的异质性和数据缺失情况。
纳入77例患者（60例TGA；17例SV）。26例（34%）出现新发脑损伤。在心脏手术后的头24小时内，有新发脑损伤和无新发脑损伤的SV患者，HR中位数（四分位间距）分别为172.0次/分钟（bpm）（169.7 - 176.0 bpm）和159.6 bpm（145.0 - 167.0 bpm）；收缩压分别为74.8（67.9 - 78.5 mmHg）和68.9 mmHg（61.6 - 70.9 mmHg）。较高的术后HR（参数估计值，19.4；95%置信区间，7.8 - 31；P = 0.003）和BP（8.6；1.3 - 15.8；P = 0.024）与SV患者的新发脑损伤相关。这种关系的强度随时间减弱。
对连续生理测量值进行回顾性分析可以深入了解术后生理学随时间的变化及其与新发脑损伤的关系。该技术可用于评估生理数据与许多患者干预措施或结局之间的关系。
