Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure

Staehler, Helena; Ono, Masamichi; Schober, Patrick; Kido, Takashi; Heinisch, Paul Philipp; Strbad, Martina; Vodiškar, Janez; Cleuziou, Julie; Lemmer, Julia; Balling, Gunter; Hager, Alfred; Ewert, Peter; Hörer, Jürgen

doi:10.1093/ejcts/ezac014

Cited by 10 publications

(4 citation statements)

References 30 publications

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“…Our results demonstrated that the early hemodynamic variable like VIS and MAP might be associated with LOS in ICU. The early hemodynamic variables such as systolic arterial pressure, diastolic arterial pressure and serum lactate level are strong predictive marks of LOS in ICU after the Norwood procedure [15]. There is signi cant right atrial and right ventricular volume overload, the left atrium is frequently small and the left ventricle compressed by the dilated right ventricle in TVPVC [7].…”

Section: Resultsmentioning

confidence: 99%

Risk factors associated with prolonged postoperative intensive care unit stay in total anomalous pulmonary venous connection

Huang

Tang

Yang

et al. 2022

Preprint

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Objective Prolonged intensive care unit stay occupies medical resources and increases medical cost. The present study aimed to identify the risk factors associated with prolonged postoperative intensive care unit (ICU) stay in total anomalous pulmonary venous connection (TAPVC). Methods The medical records of 85 patients who underwent TAPVC correction surgery were retrospectively analyzed. Patients were divided into the prolonged stay group and the standard stay group. The prolonged stay group included all the patients exceeding the 75th percentile for duration of ICU stay, and the standard stay group included all the remaining patient. The effect of patient variables on the ICU stay duration was investigated using univariate analysis and logistic regression analysis. Results The median age of 85 patients was 41 (18–103) days, median weight was 3.80 (3.30–5.35) kg. According to the grouping criteria, the postoperative duration of ICU stay in prolonged stay group (n = 23) was 11–68 days and the postoperative duration of ICU stay in standard stay group (n = 62) was 2–10 days. Preoperative lower saturation of pulse oximetry (SpO2), intraoperative higher plasma lactate level and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When the preoperative SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 hours, the risk of prolonged ICU stay was increased. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency operation, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) time and aortic clamp time, high level lactate, low temperature and large volume of ultrafiltration during CPB, large amount chest drainage, large red blood cells (RBCs) and plasma transfusion, postoperative cardiac dysfunction might be associated with prolonged ICU stay. Conclusions Preoperative lower SpO2, intraoperative higher plasma lactate level and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When the SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 hours, the risk of prolonged ICU stay was increased. Improved clinical management including early diagnosis and timely surgical intervention to reduce hypoxia time, intraoperative cardiac function protection, etc. can help to reduce ICU stay time.

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Section: Resultsmentioning

confidence: 99%

Risk factors associated with prolonged postoperative intensive care unit stay in total anomalous pulmonary venous connection

Huang

Tang

Yang

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Our results demonstrate that early hemodynamic variables, such as VIS and MAP,may be associated with LOS in the ICU. Early hemodynamic variables such as systolic arterial pressure, diastolic arterial pressure, and serum lactate level have been shown to be strong predictive markers of LOS in the ICU after the Norwood procedure [ 16 ]. In TAPVC there is significant right atrial and right ventricular volume overload, the left atrium is frequently small, and the left ventricle is compressed by the dilated right ventricle [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study

Huang,

Tang,

Fan

et al. 2023

J Cardiothorac Surg

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Background Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC). Methods The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses. Results Patient median age was 41 (18–103) days, and median weight was 3.80 (3.30–5.35) kg.Postoperative duration of ICU stay was 11–68 days in the prolonged stay group (n = 23) and 2–10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay. Conclusions Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.

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“…Incidence of inter-stage mortality has been reported to be up to 12% in a multicenter trial [4]. Previous studies have identi ed several pre-and postoperative variables as risk factors for interstage mortality [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

Staehler,

Schaeffer,

Wasner

et al. 2023

Preprint

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Background While early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, inter-stage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) reduce inter-stage mortality. Methods Among 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding inter-stage mortality. In patients with HMP, events during the inter-stage period were evaluated. Results Inter-stage mortality was 8% (n = 21) and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with inter-stage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extracorporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for inter-stage mortality. Most frequent event during home monitoring was low saturation (< 70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnant weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmia in 2 (2.5%). Unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups. Conclusions Inter-stage HMP permits timely intervention and led to an important decrease in inter-stage mortality. One-third of the patients with home monitoring program needed readmission and demonstrated the need for earlier stage 2 palliation.

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Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure

Cited by 10 publications

References 30 publications

Risk factors associated with prolonged postoperative intensive care unit stay in total anomalous pulmonary venous connection

Risk factors associated with prolonged postoperative intensive care unit stay in total anomalous pulmonary venous connection

Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

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