Article Sidebar
Views PDF: 129
Study on the role of vis (vasoactive - inotropic score) as a predictor of a poor clinical outcome in children after congenital heart surgery with cardiopulmonary bypass
Main Article Content
Abstract
Objectives: Many authors showed that the VIS (vasoactive-inotropic score) has a strong correlation with morbidity and mortality after cardiac surgery in children, but the conclusions are not completely unified. We therefore performed this study to determine the relationship between the VIS score and clinical outcomes in children undergoing cardiac surgery with extracorporeal circulation.
Method: Prospective cohort study. A total of 100 pediatric patients from birth to 2 years of age with indications for cardiac surgery with extracorporeal circulation at the Anesthesiology Department of the Heart Institute of Ho Chi Minh City from January 1, 2021, to December 31, 2021, were included in the study. Hourly doses of all vasoactive medications were recorded for the first 48 hours after admission to cardiothoracic intensive care unit and a vaso-active inotropic score was calculated. The VIS scale is calculated by the formula: VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 × adrenaline dose (µg/kg/min) + 10 × milrinone dose (µg/min) kg/min) + 10000 × vasopressin dose (U/kg/min) + 100 × noradrenaline dose (µg/kg/min). The max and mean values of VIS in the first 24 hours and the max and mean values of VIS in the subsequent 24 hours after admission (from 25th to 48th hour) were calculated.
Results: The rate of patients with low cardiac output syndrome was 38.0%. There were 20/100 cases (20.0%) with a poor outcome, of which 19 cases required peritoneal dialysis, 4/100 cases (4.0%) had cardiac arrest, 2/100 cases (2.0%) had seizures, 1/100 (1.0%) had to run ECMO and 4/100 (4.0%) died after surgery. Patients in the high VIS group (mean 48- hour VIS ≥ 11.06) compared with the low VIS group (mean 48- hour VIS < 11.06) were associated with prolonged duration of mechanical ventilation, prolonged CICU length of stay in the ICU, prolonged time to negative fluid balance.
Conclusions: The high VIS after surgery was a good predictor of a poor clinical outcome, prolonged duration of mechanical ventilation, prolonged CICU length of stay outcomes in children undergoing cardiac surgery with extracorporeal circulation
Article Details
Keywords
congenital heart surgery, low cardiac output syndrome, VIS score
References
2. Larrazabal L, Jenkins KJ., Gauvreau K., al e. Improvement in congenital heart surgery in a developing country: the Guatemalan experience. Circulation. 2007;116(17):1882-7.
3. Wernovsky G, Wypij D., Jonas R. A., Mayer JE, Jr., Hanley FL, Hickey PR, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92(8):2226-35.
4. Butts RJ, Scheurer MA., Atz AM., Zyblewski SC, Hulsey TC, Bradley SM, et al. Comparison of Maximum Vasoactive Inotropic Score and Low Cardiac Output Syndrome As Markers of Early Postoperative Outcomes After Neonatal Cardiac Surgery. Pediatric Cardiology. 2012;33(4):633-8.
5. Davidson J, Tong S., Hancock H., A H, E dC, J K. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38:1184-90.
6. Nguyễn Đức Thường, Trần Minh Điển, Đặng Văn Thức, Trịnh Xuân Long. Giá trị tiên lượng của chỉ số thuốc vận mạch (VIS) trong hồi sức sau phẫu thuật tim mở tim bẩm sinh. Y học Việt Nam. 2015;1:98-102.
7. Schroeder VA, Pearl J.M., Schwartz S.M., Shanley T.P., Manning P.B., Nelson D.P. Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression. Circulation. 2003;107(22):2823-8.
8. Nguyễn Thị Quý, Hoàng Anh Khôi, Nguyễn Minh Trí Viên, Phan Kim Phương. Kết quả sớm và theo dõi dài hạn sau phẫu thuật sửa chữa hồi lưu tĩnh mạch phổi bất thường hoàn toàn. Y học thành phố Hồ Chí Minh. 2009;13(6):146-57.
9. Gaies MG, Gurney J.G., Yen A.H., Napoli M.L., al e. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11:234-8.
10. O'Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138(5):1139-53.
11. Jenkins KJ, Gauvreau K., Newburger JW., TL S, JH M, LI I. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123:110 - 8.
12. Cavalcante CT, de Souza NMG, Pinto VC Júnior, Branco KM, Pompeu RG, et al. Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS-1 Risk Score in a Brazilian Single Center. Braz J Cardiovasc Surg. 2016 May-Jun;31(3):219-225
13. Gaies MG, Jeffries H.E., Niebler R.A., Pasquali S.K., Donohue J.E., Yu S, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med. 2014;15(6):529-37.