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Vasoactive–inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass*

Gaies, Michael G. MD, MPH; Gurney, James G. PhD; Yen, Alberta H.; Napoli, Michelle L.; Gajarski, Robert J. MD; Ohye, Richard G. MD; Charpie, John R. MD, PhD; Hirsch, Jennifer C. MD

Pediatric Critical Care Medicine: March 2010 - Volume 11 - Issue 2 - p 234-238
doi: 10.1097/PCC.0b013e3181b806fc
Continuing Medical Education Articles

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.

Design: Retrospective chart review.

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

Patients: 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.

Interventions: None.

Measurements and Main 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. (Pediatr Crit Care Med 2010; 11:234–238)

Clinical Lecturer (MGG), University of Michigan School of Medicine, Ann Arbor, MI; Associate Professor and Clinical Research Director (JGG), Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI; Medical Student (AHY), University of Michigan Medical School, Ann Arbor, MI; Student (MLN), University of Michigan School of Medicine, Ann Arbor, MI; Associate Professor (RJG), University of Michigan, Ann Arbor, MI; Associate Professor of Surgery (RGO), University of Michigan Medical School, Ann Arbor, MI; Professor of Pediatrics (JRC), University of Michigan, Ann Arbor, MI; Assistant Professor (JCH), Department of Surgery, University of Michigan, Ann Arbor, MI; and Surgical Director (JCH), Pediatric Cardiothoracic Unit, University of Michigan, Ann Arbor, MI.

Nominal funding was provided through the Department of Surgery, University of Michigan School of Medicine. Students working on the project (AHY, MN) were supported by stipends from the University of Michigan Summer Biomedical Research Program.

For information regarding this article, E-mail: mgaies@med.umich.edu

©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies