Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery

Department of Pediatrics, The Heart Institute, The Children's Hospital Colorado, Aurora, CO 80045, USA.
Intensive Care Medicine (Impact Factor: 7.21). 04/2012; 38(7):1184-90. DOI: 10.1007/s00134-012-2544-x
Source: PubMed

ABSTRACT Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) h after surgery. Maximum VIS and IS scores in the first 48 h were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine.
Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3, p = 0.002), prolonged ICU stay (OR 8.1, p = 0.017), and prolonged hospitalization (OR 11.3, p = 0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine.
In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes.

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    • "Vasoactive and inotrope needs on admission to the ICU were recorded and the vasoactive–inotrope score (VIS) [16] calculated as follows: VIS = doses of dopamine + dobutamine + 100 × epinephrine + 10 × milrinone + 10 000 × vasopressin + 100 × "
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    Intensive Care Medicine 11/2012; 39(2). DOI:10.1007/s00134-012-2709-7 · 7.21 Impact Factor
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    ABSTRACT: Objectives To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. Methods The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. Results The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. Conclusion A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.
    Anales de Pediatría 01/2013; DOI:10.1016/j.anpedi.2013.09.018 · 0.83 Impact Factor
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