Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Maneesh Kumar
2. Vijay Kher
3. Anil Bhan
4. Sidharth Sethi
5. Prerna Sharma
6. Subeeta Bazaz
ISSN
0972-5229
DOI
10.4103/0972-5229.142174
Volume
18
Issue
10
Publishing Year
2014
Pages
6
Author Affiliations
    1. Fortis Hospitals, Sector B, Pocket 1, Aruna Asaf Ali Marg, New Delhi
    2. Indraprastha Apollo Hospital, New Delhi, India, E-mail:vkher@del3.vsnl.net.in, vkher@vsnl.com
    3. Medanta Kidney and Urology Institute, Medanta–The Medicity, Gurgaon, Haryana, India
    4. Medanta Kidney and Urology Institute, Medanta—The Medicity, Gurgaon, Haryana, India
    5. Fortis Escorts Hospital, New Delhi, India
    6. Kidney and Urology Institute, Fortis Escorts Hospital, New Delhi, India
    7. Medanta Kidney and Urology Institute Medanta—The Medicity Gurugram, Haryana, India
    8. Medanta Kidney and Urology Institute, Medanta–The Medicity, Gurugram, Haryana, India
    9. Transplant Medicine, Medanta Kidney and Urology Institute, Medanta – The Medicity, Gurugram, Haryana, India
    10. Medanta Kidney and Urology, Institute, Gurgaon, Haryana, India
    1. Medanta Heart Institute, Medanta–The Medicity, Gurgaon, Haryana, India
    2. Medanta Heart Institute, Medanta—The Medicity, Gurugram, Haryana, India
    3. Medanta Heart Institute, Medanta–The Medicity, Gurugram, Haryana, India
    4. Medanta—The Medicity, Gurugram, Haryana, India
    5. Medanta–The Medicity, Gurugram, Haryana, India
    6. Medanta—The Medicity, Gurgaon, Haryana, India
    1. Department of Pediatric Critical Care and Pulmonology, Sri Balaji Action Medical Institute, New Delhi, India
    1. Cardiothoracic Surgery, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
    1. Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
    1. Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
  • Article keywords
    Cardiac surgery, cardiopulmonary bypass, infants, inotropes

    Abstract

    Background: Neonates and infants undergoing heart surgery on cardiopulmonary bypass (CPB) are at high risk for significant post-operative morbidity and mortality. Hence, there is a need to identify and quantify clinical factors during the early post-operative period that are indicative of short-term as well as long-term outcomes. Multiple inotrope scores have been used in practice to quantify the amount of cardiovascular support received by neonates. Aims: The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcomes in children after open cardiac surgery. Materials and Methods: This is a retrospective analysis of the 208 patients who underwent cardiac surgery for congenital heart disease at a tertiary pediatric cardiac surgery Intensive Care Unit (ICU) from January 2012 to March 2013. Multiple demographic, intra-operative and post-operative variables were recorded, including the Vasoactive Inotrope Score (VIS). Results: A total of 208 patients underwent cardiac surgery for congenital heart disease in the study period. The mean age and weight in the study were 66.94 months and 16.31 kg, respectively. Statistically significant associations were found in the various variables and VIS, including infancy, weight < 10 kg, CPB time, pump failure and post-operative variables like sepsis, hematological complications, hepatic dysfunction, acute kidney injury during admission, mortality, prolonged ventilator requirement, CPB time (in min) and hospital stay. Conclusions: Inotrope score and its adaptations are an excellent tool to measure illness severity, deciding interventions and during parental counseling in the pediatric cardiac surgery ICUs.

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