Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

Abbas, Qalab; Hussain, Muhammad Zaid H.; Shahbaz, Fatima Farrukh; Siddiqui, Naveed; Hasan, Babar

doi:10.3389/fped.2022.846074

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…Recently, the inadequate delivery of oxygen (IDO 2 ) index has been described and used at many heart centers for pediatric patients following cardiac surgery ( 15 ). In a retrospective multicenter study including infants following CPB operations, Futterman et al ( 16 ) showed that a higher IDO 2 index dose over a monitoring period of 2 hours was associated with an increased risk of cardiac arrest even when censoring data 10–30 minutes before the event.…”

Section: Discussionmentioning

confidence: 99%

A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients

Asfari,

Wolovits,

Gazit

et al. 2023

Critical Care Explorations

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BACKGROUND: Postoperative pediatric congenital heart patients are predisposed to develop low-cardiac output syndrome. Serum lactate (lactic acid [LA]) is a well-defined marker of inadequate systemic oxygen delivery. OBJECTIVES: We hypothesized that a near real-time risk index calculated by a noninvasive predictive analytics algorithm predicts elevated LA in pediatric patients admitted to a cardiac ICU (CICU). DERIVATION COHORT: Ten tertiary CICUs in the United States and Pakistan. VALIDATION COHORT: Retrospective observational study performed to validate a hyperlactatemia (HLA) index using T3 platform data (Etiometry, Boston, MA) from pediatric patients less than or equal to 12 years of age admitted to CICU (n = 3,496) from January 1, 2018, to December 31, 2020. Patients lacking required data for module or LA measurements were excluded. PREDICTION MODEL: Physiologic algorithm used to calculate an HLA index that incorporates physiologic data from patients in a CICU. The algorithm uses Bayes’ theorem to interpret newly acquired data in a near real-time manner given its own previous assessment of the physiologic state of the patient. RESULTS: A total of 58,168 LA measurements were obtained from 3,496 patients included in a validation dataset. HLA was defined as LA level greater than 4 mmol/L. Using receiver operating characteristic analysis and a complete dataset, the HLA index predicted HLA with high sensitivity and specificity (area under the curve 0.95). As the index value increased, the likelihood of having higher LA increased (p < 0.01). In the validation dataset, the relative risk of having LA greater than 4 mmol/L when the HLA index is less than 1 is 0.07 (95% CI: 0.06-0.08), and the relative risk of having LA less than 4 mmol/L when the HLA index greater than 99 is 0.13 (95% CI, 0.12–0.14). CONCLUSIONS: These results validate the capacity of the HLA index. This novel index can provide a noninvasive prediction of elevated LA. The HLA index showed strong positive association with elevated LA levels, potentially providing bedside clinicians with an early, noninvasive warning of impaired cardiac output and oxygen delivery. Prospective studies are required to analyze the effect of this index on clinical decision-making and outcomes in pediatric population.

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Section: Discussionmentioning

confidence: 99%

A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients

Asfari,

Wolovits,

Gazit

et al. 2023

Critical Care Explorations

Self Cite

View full text Add to dashboard Cite

show abstract

“…The tool also showcased modest results for a population that is geographically diverse. 20 Another study evaluating the outcome of implementation of IDO 2 among children who underwent cardiac surgery for congenital heart defects with subsequent admission to PICU, found that in comparison to the Cardiac Children's Hospital Early Warning Score (C-CHEWS) which has been previously validated to assess clinical deterioration and pick early warning signs in children with heart diseases, when compared to IDO 2 found that no significant statistical difference existed between the two methods in picking up an association between adverse events among patients. The median C-CHEWS scores were significantly higher in those who had an adverse event, 4.03 (IQR, 2.39-5.15) versus 2.77 (IQR, 2.06-3.39), p = 0.003.…”

Section: Current Use and Outcomes Of This Tool In A Tertiary Care Pae...mentioning

confidence: 99%

Novel data visualization and risk analytic algorithm in a low-middle income country

Hina Inam,

Fatima Amjad,

Abdul Ahad Sohail

et al. 2024

J Pak Med Assoc

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To discuss the use of T3™, a data aggregation, visualization, and risk analytic platform in a single centre and its framework for implementation of such a tool in clinical care. We share experience of a tool implemented in a tertiary care Intensive Care Unit (ICU) with limited resources. Superusers were identified and trained. Implementation involved monitoring, evaluation, and user engagement data for continuous emphasis on the use of this tool. Persistent display of T3 data enhanced nursing operational efficiency. Its use was expanded to use in nurses rounds and handover, mortality and morbidity meetings, clinical team teaching through selected teaching cases and analysis of stored data with different research questions. However, lack of infrastructure and technological comprehension, paucity of multidisciplinary teams makes it a challenge in its implementation. Continue...

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The Inadequate Oxygen Delivery Index and Its Correlation with Venous Saturation in the Pediatric Cardiac Intensive Care Unit

Loomba,

Villarreal,

Flores

et al. 2023

Pediatr Cardiol

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BackgroundContinuous monitoring software, T3, has an integrated index called the inadequate oxygen delivery index 50% (IDO2-50%) which displays a probability that the mixed venous saturation is below a user-selected threshold of 30-50%. The primary aim of this study was to determine the correlation of the IDO2-50% with a measured venous saturation. The secondary aim of this study was to characterize the hemodynamic factors that contributed to the IDO2-50%. MethodsThis single-center, retrospective study aimed to characterize the correlation between IDO2-50% and inferior vena cava (IVC) saturation. A Bayesian Pearson correlation was conducted to assess the correlation between the collected variables of interest, with a particular interest in the correlation between the IDO2-50% and the IVC saturation. Receiver operator curve (ROC) analysis to assess the ability of the IDO2-50% to identify when the venous saturation was less than 50%. Bayesian linear regression was done with the IDO2-50% (dependent variable) and other independent variables. ResultsA total of 113 datasets were collected across 15 unique patients. IDO2-50% and the IVC saturation had moderate correlation with the IVC saturation (correlation coe cient − 0.569). The IDO2-50% had a weak but signi cant correlation with cerebral near infrared spectroscopy (NIRS) values, a weak but signi cant correlation with heart rate, and a moderate and signi cant correlation with arterial saturation. ROC analysis demonstrated that the IDO2-50% had a good ability to identify a venous saturation below 50%, with an area under the curve of 0.797, cutoff point of 24.5 with a sensitivity of 81%, speci city of 66%, positive predictive value of 44% and negative predictive value of 91%. Bayesian linear regression analysis yielded the following model: 237.82 + (1.18 x age in months) -(3.31 x arterial saturation) -(1.92 x cerebral NIRS) + (0.84 x heart rate). ConclusionThe IDO2 index has moderate correlation with IVC saturation. It has good sensitive and negative predictive value. Cerebral NIRS does appear to correlate better with the underlying venous saturation than the IDO2 index.

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Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

Cited by 4 publications

References 28 publications

A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients

A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients

Novel data visualization and risk analytic algorithm in a low-middle income country

The Inadequate Oxygen Delivery Index and Its Correlation with Venous Saturation in the Pediatric Cardiac Intensive Care Unit

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