Association of Immediate Postoperative Hemodynamic and Laboratory Values in Predicting Norwood Admission Outcomes

Abstract

BackgroundThe primary objective of this study was to determine whether or not hemodynamic parameters and laboratory values at the time of admission to the pediatric cardiac intensive care unit after the Norwood operation were associated with a composite outcome of either need for extracorporeal membrane oxygenation or inpatient mortality. MethodsThis was a single-center retrospective study of infants with functionally univentricular hearts admitted to intensive care after the Norwood procedure from January 2011 to January 2020. Data were obtained at a single point(after a Norwood procedure) and then compared between two subsets of patients based on the presence or not of the composite outcome of interest. In univariate and multiple regression analyses, a series of receiver operator curves were generated to assess the relationship between the variables of interest and the composite outcome. ResultsEight(7.6%) experienced the composite outcome out of a total of 104 patients. Those who experienced the composite endpoint had signi cantly higher oxygen extraction ratio (0.43 vs. 0.31, p = 0.01), lower systemic blood ow (2.5 L/min versus 3.1 L/min, p = 0.01), and higher systemic vascular resistance (20.2 indexed woods units versus 14.8 indexed woods units, p = 0.01). Those with systemic blood ow of less than 2.5 L/min/m 2 had a 17% risk of experiencing the composite endpoint AUC = 0.79. Those with systemic vascular resistance of greater than 19 indexed woods units had a 22% risk of experiencing the composite endpoint AUC 0.80. ConclusionSystemic blood ow and systemic vascular resistance are independently associated with this composite outcome.

Factors associated with renal oxygen extraction in mechanically ventilated children after the Norwood operation: insights from high fidelity hemodynamic data

“…Increased oxygen extraction has been demonstrated to increased morbidity and mortality, with oxygen extraction of 30 to 40 being demonstrated as a period at which the risk of morbidity such as impaired neurodevelopment, acute kidney injury, hepatic insu ciency, necrotizing enterocolitis, and cardiac arrest increase [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

“…This leads to higher morbidity and mortality, as well [2][3][4]. Management of these patients thus requires thorough understanding of the principles that underpin this circulation, how to adequately monitor these patients, as well as the impacts of various clinical interventions in this circulation [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The role of central venous pressures and what factors are associated with central venous pressure in patients with parallel circulation have not been well described.…”