Evaluation of the Performance of Vasoactive Ventilation Renal Score in Predicting the Duration of Mechanical Ventilation and Intensive Care Hospitalization After Pediatric Cardiac Surgery

Havan, Merve; Emekli, Burak; Özcan, Serhan; Gün, Emrah; Ramoğlu, Mehmet Gökhan; Karagözlü, Selen; Yaman, Nur Dikmen; Erdoğan, Beyza Doğanay; Ucar, Tayfun; Eyileten, Zeynep; Tutar, Ercan; Uysalel, Adnan; Kendirli, Tanıl

doi:10.1007/s00246-022-03016-6

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Miletic et al proposed using this score and, in a prospective study, showed that 48th-h VVR score predicted both LOS and prolonged mechanical ventilation duration better than VIS and serum lactate ( 11 , 16 ). A study conducted by Havan et al found the 48-h VVR score to be an effective predictor of the LOS and duration of mechanical ventilation in children postcardiac surgery, as found in our study ( 28 ). Another retrospective study conducted by Ozturk et al found that the VVR score at 48 h is a useful tool in determining the duration of ICU stay and hospital mortality in children postcardiac surgery ( 18 ).…”

Section: Discussionsupporting

confidence: 87%

Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery

et al. 2023

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IntroductionThere is a need to index important clinical characteristics in pediatric cardiac surgery that can be obtained early in the postoperative period and accurately predict postoperative outcomes.MethodologyA prospective cohort study was conducted in the pediatric cardiac ICU and ward on all children aged <18 years undergoing cardiac surgery for congenital heart disease from September 2018 to October 2020. The vasoactive-ventilation-renal (VVR) score was analyzed to predict outcomes of cardiac surgeries with a comparison of postoperative variables.ResultsA total of 199 children underwent cardiac surgery during the study period. The median (interquartile range) age was 2 (0.8–5) years, and the median weight was 9.3 (6–16) kg. The most common diagnoses were ventricular septal defect (46.2%) and tetralogy of Fallot (37.2%). At the 48th h, area under the curve (AUC) (95% CI) values were higher for the VVR score than those for other clinical scores measured. Similarly, at the 48th h, AUC (95% CI) values were higher for the VVR score than those for the other clinical scores measured for the length of stay and mechanical ventilation.DiscussionThe VVR score at 48 h postoperation was found to best correlate with prolonged pediatric intensive care unit (PICU) stay, length of hospitalization, and ventilation duration, with the greatest AUC-receiver operating characteristic (0.715, 0.723, and 0.843, respectively). The 48-h VVR score correlates well with prolonged ICU, hospital stay, and ventilation.

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Section: Discussionsupporting

confidence: 87%

Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery

et al. 2023

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“…The VVR score, which includes the VIS, Ventilation Index Score, and preoperative and postoperative changes in creatinine levels, is considered a reliable predictor of prognosis in pediatric patients after congenital heart surgery. The predictive performance of the VVR score is superior to that of the VIS ( 19 ), although the VIS has been shown to predict the prognosis of patients undergoing post-cardiac surgery, primarily reflecting the patient's postoperative cardiovascular condition and does not consider the impact of other functions of the organ system on the patient. Therefore, the VVR score, which includes indicators of cardiovascular, respiratory, and renal function, can better reflect the burden on various systems in patients after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Prediction of ventilator weaning failure in postoperative cardiac surgery patients using vasoactive-ventilation-renal score and nomogram analysis

Zhang,

Tang,

Ren

et al. 2024

Front. Cardiovasc. Med.

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ObjectiveThis study evaluated the predictive value of the vasoactive-ventilation-renal (VVR) score in identifying the risk of weaning failure after cardiac surgery and developing a nomogram model to help physicians improve the success rate of weaning from mechanical ventilation in adult patients undergoing postoperative cardiac surgery.MethodsClinical data were retrospectively collected from adult patients who underwent extracorporeal circulation cardiac surgery at the First Affiliated Hospital of Nanjing Medical University between August 2022 and April 2023 and who were subsequently transferred to the Intensive Care Unit (ICU) and treated with vasoactive drugs. Patients were divided into successful and unsuccessful weaning groups based on first-attempt weaning success. Variable selection was regularized using univariate logistic regression and Least absolute shrinkage and selection operator (LASSO) regularization. Multivariate logistic regression was performed to identify predictors and a nomogram was created to predict the risk of weaning failure.ResultsA total of 519 patients were included in the study. After selecting multiple stepwise variables, the VVR score before weaning, the modified Sequential Organ Failure Assessment (mSOFA) score on weaning day, and mechanical ventilation duration before weaning were determined as predictive indicators of weaning failure in adult patients after cardiac surgery. The optimal cut-off values for these indicators were 18.46 points, 4.33 points, and 20.50 h, respectively. The predictive model constructed using these three factors demonstrated good predictive performance.ConclusionsThe VVR score before weaning accurately predicts the probability of weaning failure in adult patients after cardiac surgery. The weaning risk-predictive nomogram model, established based on the VVR score, mSOFA score, and mechanical ventilation duration before weaning, demonstrated robust predictive ability.

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Definition, risk factors, and outcome analysis of prolonged mechanical ventilation in children

Chen,

Liu,

Dang

2024

Pediatric Pulmonology

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ObjectiveThis study aims to explore the time threshold for defining prolonged mechanical ventilation (PMV) in children, along with its risk factors and outcomes.MethodsA prospective cohort study was conducted on children aged 29 days–18 years, who were consecutively admitted to two Pediatric Intensive Care Units (PICUs) at Children's Hospital of Chongqing Medical University, from October 2020 to June 2021. The study included patients receiving mechanical ventilation (MV) for more than 2 days (each day >6 h). Participants were divided into five groups based on the duration of MV (2–7 days, 8–14 days, 15–21 days, 21–30 days, >30 days) to compare rates of extubation failure, all‐cause mortality one month post‐discharge, incidence of ventilator‐associated pneumonia, tracheotomy rates, total hospital stay, PICU stay, and overall hospital costs. The most clinically and statistically significant outcome variables were selected. The Youden index was used to determine the MV duration with the most significant impact on overall outcomes, defining this as PMV. Baseline characteristics, treatment information, and outcomes were compared between PMV and non‐PMV groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for PMV occurrence.ResultsA total of 382 subjects were included in the study. The distribution of children across the five MV duration groups was 44.2%, 27.7%, 10.7%, 8.9%, and 8.4% respectively. The rates of at least one extubation failure in each group were 5.9%, 10.4%, 41.5%, 41.2%, and 46.9% (p < .05). Statistically significant differences were observed among groups in terms of tracheotomy rates, all‐cause mortality at 1 month postdischarge, median total hospital stay, median PICU stay, and hospital costs (p < .05). Defining PMV, the most appropriate time point calculated was 12.5 days, based on at least one extubation failure and/or death within 1 month postdischarge. Higher PIM‐3 scores, weight for age <−2SD, admission for respiratory distress/insufficient ventilation and/or hemodynamic instability/shock/arrhythmia, noninvasive ventilation on the first day, and undergoing blood transfusion treatment were identified as risk factors for PMV (p < .05).ConclusionIn children, MV for ≥13 days significantly increases mortality rates, extubation failure and tracheotomy rates, duration of PICU and total hospital stay and costs. We suggest defining PMV as MV ≥13 days, particularly for children undergoing MV for respiratory illnesses. This definition can assist clinicians in developing appropriate treatment strategies by focusing on risk factors and providing reliable prognostic consultation to patients' families.

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Evaluation of the Performance of Vasoactive Ventilation Renal Score in Predicting the Duration of Mechanical Ventilation and Intensive Care Hospitalization After Pediatric Cardiac Surgery

Cited by 4 publications

References 18 publications

Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery

Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery

Prediction of ventilator weaning failure in postoperative cardiac surgery patients using vasoactive-ventilation-renal score and nomogram analysis

Definition, risk factors, and outcome analysis of prolonged mechanical ventilation in children

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