Inotropic score and vasoactive inotropic score as predictors of outcomes in congenital diaphragmatic hernia: A single center retrospective study

Abstract

BackgroundNeonates with congenital diaphragmatic hernia (CDH) have varying degrees of pulmonary hypoplasia, pulmonary hypertension (PH) and cardiac dysfunction. These neonates frequently require vasoactive support and are at high risk for mortality and morbidity, including prolonged ventilator support, need for extracorporeal membrane oxygenation (ECMO), prolonged length of stay, and need for tracheostomy. However, identifying which infants are at increased risk can be challenging. In this study, we sought to investigate the utility of the inotropic score (IS) and vasoactive inotropic score (VIS) as tools to predict significant clinical outcomes and overall survival in patients with CDH. Additionally, we evaluated the correlation between IS/VIS and postnatal echocardiographic variables.MethodsThis was a retrospective chart review of 57 patients with CDH whose postnatal care was based on a standardized institutional protocol. We calculated the IS/VIS at 6-, 12-, 24-, 48 hours of life (HOL), on the day of CDH repair and 24- and 48 hours after surgical repair. The association of these scores with postnatal echocardiographic markers was analyzed using Pearson's correlation and linear regression, while logistic regression was used for binary outcomes, and Cox proportional hazards regression was used to assess associations with survival.ResultsWe found that every one-unit increase in IS/VIS at 6 HOL was associated with 13% increase in the odds of ECMO (p = 0.034) and 10.1% increase in risk of death (p = 0.021). An increase in IS/VIS at 12-, 24- and 48-HOL was associated with posterior septal bowing in the first postnatal echocardiogram (p < 0.05 for all). Additionally, we noted an inverse relationship between IS (r = −0.281, p = 0.036) and VIS (r = −0.288, p = 0.031) on the day of repair and left ventricle (LV) systolic function in first postnatal echocardiogram. Increase in IS (r = −0.307, p = 0.024) and VIS (r = −0.285, p = 0.037) on the day of repair was associated with decreased LV function on the post-repair echocardiogram.ConclusionThis retrospective study showed a significant association between IS/VIS obtained at various time points with clinical outcomes and echocardiographic findings in CDH, which could be used to guide prognosis and management in this patient population.

A comparative analysis of the Vasoactive‐Inotropic Score, the Vasoactive‐Ventilation‐Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia

“…Gopal et al evaluated the Inotropic Score (IS) and the VIS in a retrospective single-center cohort of 57 CDH infants. 8 In conclusion, the authors found the IS/VIS at 6 h of life to be independently associated with the clinical outcome (ECMO and ) as an appropriate independent risk factor for in-hospital mortality. The authors report an optimal cut-off of >17 for the hosVIS…”

“…In two recently published studies, the VIS was evaluated in the CDH population. Gopal et al evaluated the Inotropic Score (IS) and the VIS in a retrospective single‐center cohort of 57 CDH infants 8 . In conclusion, the authors found the IS/VIS at 6 h of life to be independently associated with the clinical outcome (ECMO and death) and echocardiographic severity parameters of cardiac function, as atrial level shunting, interventricular septal flattening and bowing, and LV function.…”

“…The Oxygenation Index (OI) is a widely used parameter for the estimation of oxygenation impairment, need for ECMO and survival in CDH infants 4–6 . Another index which calculates the actual amount of inotropic and vasopressor therapy in CDH infants or critical ill neonates is the Vasoactive‐Inotropic Score (VIS), which was found recently to correlate significantly with echocardiographic markers of cardiac impairment, need for ECMO and mortality in CDH infants 7,8 . The VIS was first described in neonates in 2010 by Gaies et al 9 In the population of infants postcardiac surgery the Vasoactive‐Ventilation‐Renal (VVR) Score as an extension of the VIS was evaluated in several studies and found to be an adequate predictor of in‐hospital LOS, duration of MV, and survival to discharge 10–12 .…”

“…[4][5][6] Another index which calculates the actual amount of inotropic and vasopressor therapy in CDH infants or critical ill neonates is the Vasoactive-Inotropic Score (VIS), which was found recently to correlate significantly with echocardiographic markers of cardiac impairment, need for ECMO and mortality in CDH infants. 7,8 The VIS was first described in neonates in 2010 by Gaies et al 9 In the population of infants postcardiac surgery the Vasoactive-Ventilation-Renal (VVR) Score as an extension of the VIS was evaluated in several studies and found to be an adequate predictor of in-hospital LOS, duration of MV, and survival to discharge. [10][11][12] The VVR Score addresses different organ systems which are included in the disease cascade of CDH pathophysiology, and, therefore, seems a promising tool as multimodal risk stratification.…”

Frequency domain analysis of photoplethysmographic and arterial pressure waveforms for assessing hemodynamics in children with congenital heart surgery

“…Although the cutoff values were derived from our study’s dataset, they may be broadly applicable, as most studies investigating fluid responsiveness have selected a fluid bolus dose of 10 ml/kg [ 6 ]. Regarding higher VIS, it has been reported that VIS > 5–10 is associated with postoperative outcomes [ 22 , 23 ].…”