Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass.
OBJECTIVE
Inotrope score has been proposed as a marker of illness severity after pediatric cardiac surgery despite a lack of data to support its use as such. The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcome in infants after cardiac surgery.


METHODS
Retrospective chart review.


METHODS
Dedicated pediatric cardiothoracic intensive care unit at an academic, tertiary care medical center.


METHODS
One hundred seventy-four patients 0 to 6 months of age admitted to the cardiothoracic intensive care unit after cardiac surgery with cardiopulmonary bypass between August 2007 and June 2008. Forty-three percent were neonates, and 39% had functional single ventricle physiology.


METHODS
None.


RESULTS
Hourly doses of all vasoactive medications were recorded for the first 48 hrs after admission to the cardiothoracic intensive care unit and a vasoactive-inotropic score was calculated. The maximum vasoactive-inotropic score level over the first 48 hrs was a good predictor of poor clinical outcome (death, cardiac arrest, mechanical circulatory support, renal replacement therapy, and/or neurologic injury). After controlling for diagnosis, high maximum vasoactive-inotropic score was strongly associated with a poor outcome with an adjusted odds ratio of 8.1 (95% confidence interval, 3.4-19.2; p < .001) compared with patients with a low maximum vasoactive-inotropic score. High vasoactive-inotropic score was also associated with prolonged cardiothoracic intensive care unit stay, duration of mechanical ventilation, and time to negative fluid balance.


CONCLUSIONS
The amount of cardiovascular support in the first 48 hrs after congenital heart surgery with cardiopulmonary bypass predicts eventual morbidity and mortality in young infants. The degree of support is best characterized by a maximum vasoactive-inotropic score obtained during this period. The usefulness of vasoactive-inotropic score as an independent predictor of clinical outcome in infants after cardiac surgery may have important implications for future cardiothoracic intensive care unit research.
Gaies
Michael G
MG
University of Michigan School of Medicine, Ann Arbor, MI, USA. mgaies@med.umich.edu
Gurney
James G
JG
Yen
Alberta H
AH
Napoli
Michelle L
ML
Gajarski
Robert J
RJ
Ohye
Richard G
RG
Charpie
John R
JR
Hirsch
Jennifer C
JC
D002315:Cardiopulmonary Bypass / Q000401:mortality*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008485:Medical Audit; D009200:Myocardial Contraction / Q000187:drug effects*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D014665:Vasodilator Agents