title: Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery.
abstract: OBJECTIVE
  Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, The Heart Institute, The Children's Hospital Colorado, Aurora, CO 80045, USA. jesse.davidson@childrenscolorado.org
authors.forename: Jesse
authors.initials: J
authors.lastname: Davidson
authors.forename: Suhong
authors.initials: S
authors.lastname: Tong
authors.forename: Hayley
authors.initials: H
authors.lastname: Hancock
authors.forename: Amanda
authors.initials: A
authors.lastname: Hauck
authors.forename: Eduardo
authors.initials: E
authors.lastname: da Cruz
authors.forename: Jon
authors.initials: J
authors.lastname: Kaufman
mesh_terms: D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007440:Intubation / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents