An Elevated Low Cardiac Output Syndrome Score Is Associated With Morbidity in Infants After Congenital Heart Surgery*

Ulate, Kalia P.; Yanay, Ofer; Jeffries, Howard E.; Baden, H; Gennaro, Jane L. Di; Zimmerman, Jerry J.

doi:10.1097/pcc.0000000000000979

Cited by 36 publications

(21 citation statements)

References 23 publications

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“…The secondary outcome was LCOS and for this study LCOS for POD 1(post-op day1 arrival from OR to CICU until midnight), POD 2 and POD 3 was studied and was classified into five categories as mild : single vasoactive agent or arterial lactate < 2; moderate : two vasoactive agents or arterial lactate between 2 to 5; severe : three or more vasoactive agents or arterial lactate > 5; mechanical support : requirement of extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD); and finally, death . This endpoint was chosen because elevated lactate levels and more number of vasoactive agents with higher dosage have been associated with worse clinical outcomes 1, 15, 16 .…”

Section: Methodsmentioning

confidence: 99%

Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*

Flores

Cooper

Opoka

et al. 2018

Pediatric Critical Care Medicine

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Increasing glucocorticoid receptor levels in peripheral WBCs of children undergoing cardiac surgery are associated with a longer time to being inotrope free. Cortisol levels minimally increased during the study duration. These results suggest that exposure to high-dose perioperative corticosteroids may suppress the hypothalamic-pituitary-adrenal axis leading to increase in glucocorticoid receptor levels in response to a low cortisol environment. Further studies are required to better delineate the interplay between glucocorticoid receptor levels, cortisol levels, corticosteroid exposure, and postoperative inotropic requirements.

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Section: Methodsmentioning

confidence: 99%

Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*

Flores

Cooper

Opoka

et al. 2018

Pediatric Critical Care Medicine

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“…A point is given for each indicator that is present. In the prospective evaluation of LCOSS carried out by Ulate et al (11), measurements of LCOSS were recorded at arrival on CICU, and at 8,12, and 24 hours postoperatively and used to calculate a peak and cumulative LCOSS, and in a single centre study this was found to be strongly linked to a composite measure of post-operative morbidity.…”

Section: Measurements and Main Resultsmentioning

confidence: 99%

“…The LCOSS score for the equivalent 12 hour period was calculated for each of the study patients based on the clinical and laboratory criteria set out by Ulate et al (11). One difference in the application of the LCOSS score in our study was that data were retrospective, hence the timing of measurements could not be controlled, hence we refer to this as a modified LCOSS (mLCOSS).…”

Section: Methodsmentioning

confidence: 99%

The Inadequate Oxygen Delivery Index and Low Cardiac Output Syndrome Score As Predictors of Adverse Events Associated With Low Cardiac Output Syndrome Early After Cardiac Bypass*

Rogers

Ray

Johnson

et al. 2019

Pediatric Critical Care Medicine

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supporting Libby Rogers. The remaining authors have disclosed that they do not have any potential conflicts of interest.derive scores for the first 12 hours after surgery. The IDO2 Index was calculated by Etiometry using vital signs and laboratory data. A modified LCOSS (mLCOSS) was calculated from clinical and therapeutic markers. The mean IDO2 and mLCOSS were compared within each matched pair using the Wilcoxon signed-rank test. IDO2 correctly differentiated adverse events in 13/28 matched pairs, with no evidence of IDO2 being higher in cases (p=0.71). mLCOSS correctly differentiated adverse events in 23/28 matched pairs, with strong evidence of a raised score in LCOS cases (p<0.01). ConclusionsAlthough IDO2 is an FDA approved indicator of risk for low mixed venous oxygen saturation, early post-operative average values were not linked with medium term adverse events. The indicators included in the mLCOSS had a much stronger association with the specified adverse events.

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“…Several scoring systems have been created that are designed to evaluate patients for the condition and predict poor outcomes in the postoperative period. 16,17 Ulate et al 17 developed an LCOS score that used specific criteria to identify LCOS; they found the score to be useful as a predictor of morbidity and resource use in their patient population. Such scoring systems may serve as useful bedside nursing tools facilitating awareness of the presence of LCOS and appropriate communication with the medical team.…”

Section: Discussionmentioning

confidence: 99%

Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey

Nordness

Westrick

Chen

et al. 2019

Critical Care Nurse

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BACKGROUND Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart’s inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. OBJECTIVE To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. METHODS An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children’s hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. RESULTS The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. CONCLUSIONS Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.

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An Elevated Low Cardiac Output Syndrome Score Is Associated With Morbidity in Infants After Congenital Heart Surgery*

Cited by 36 publications

References 23 publications

Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*

Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*

The Inadequate Oxygen Delivery Index and Low Cardiac Output Syndrome Score As Predictors of Adverse Events Associated With Low Cardiac Output Syndrome Early After Cardiac Bypass*

Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey

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