Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery

OBJECTIVES:. Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantl...

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Autores principales:	Michael P. Goldsmith, MD, Vinay M. Nadkarni, MD, MS, Craig Futterman, MD, Avihu Z. Gazit, MD, Dimitar Baronov, PhD, Adam Tomczak, PhD, Peter C. Laussen, MBBS, Joshua W. Salvin, MD, MPH
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/176befc9cd204af38a35eee5b74222fa
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spelling	oai:doaj.org-article:176befc9cd204af38a35eee5b74222fa2021-11-25T07:56:59ZUse of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery2639-802810.1097/CCE.0000000000000563https://doaj.org/article/176befc9cd204af38a35eee5b74222fa2021-11-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000563https://doaj.org/toc/2639-8028OBJECTIVES:. Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. DESIGN:. Multicenter retrospective cohort study. SETTING:. Three pediatric cardiac ICUs at tertiary academic children’s hospitals. PATIENTS:. Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Postoperative patients were identified who successfully weaned off initial vasoactive infusions (n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) (n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [sd 19.0] vs 6.4 [sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5–6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007). CONCLUSIONS:. During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.Michael P. Goldsmith, MDVinay M. Nadkarni, MD, MSCraig Futterman, MDAvihu Z. Gazit, MDDimitar Baronov, PhDAdam Tomczak, PhDPeter C. Laussen, MBBSJoshua W. Salvin, MD, MPHWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 11, p e0563 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Michael P. Goldsmith, MD Vinay M. Nadkarni, MD, MS Craig Futterman, MD Avihu Z. Gazit, MD Dimitar Baronov, PhD Adam Tomczak, PhD Peter C. Laussen, MBBS Joshua W. Salvin, MD, MPH Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
description	OBJECTIVES:. Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. DESIGN:. Multicenter retrospective cohort study. SETTING:. Three pediatric cardiac ICUs at tertiary academic children’s hospitals. PATIENTS:. Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Postoperative patients were identified who successfully weaned off initial vasoactive infusions (n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) (n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [sd 19.0] vs 6.4 [sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5–6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007). CONCLUSIONS:. During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.
format	article
author	Michael P. Goldsmith, MD Vinay M. Nadkarni, MD, MS Craig Futterman, MD Avihu Z. Gazit, MD Dimitar Baronov, PhD Adam Tomczak, PhD Peter C. Laussen, MBBS Joshua W. Salvin, MD, MPH
author_facet	Michael P. Goldsmith, MD Vinay M. Nadkarni, MD, MS Craig Futterman, MD Avihu Z. Gazit, MD Dimitar Baronov, PhD Adam Tomczak, PhD Peter C. Laussen, MBBS Joshua W. Salvin, MD, MPH
author_sort	Michael P. Goldsmith, MD
title	Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
title_short	Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
title_full	Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
title_fullStr	Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
title_full_unstemmed	Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
title_sort	use of a risk analytic algorithm to inform weaning from vasoactive medication in patients following pediatric cardiac surgery
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/176befc9cd204af38a35eee5b74222fa
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Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery

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