Predictors of Outcome in Cardiac Surgical Patients With Prolonged Intensive Care Stay

Ryan, Thomas; Rady, Mohamed Y.; Bashour, C. Allen; Leventhal, Marvin; Lytle, Bruce W.; Starr, Norman J.

doi:10.1378/chest.112.4.1035

Cited by 108 publications

(83 citation statements)

References 32 publications

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“…1,2 Moreover, several pathophysiological changes may be obscured by the influence of system support devices, such as intraaortic balloon pumps, ventricular assist devices, hemofiltration, and mechanical ventilation. [1][2][3][4][5][6][7][8][9] Nevertheless, several of the general scoring systems have been subsequently validated and are currently in use in CSICUs, owing to the lack of a suitable and qualified system for this specific population. The most established are the Acute Physiology and Chronic Health Evaluation (APACHE) II, 10 the Simplified Acute Physiology Score (SAPS) II, 11 and the Sequential Organ Failure Assessment (SOFA), 12 with a good reported performance.…”

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confidence: 99%

Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study

Exarchopoulos

Charitidou

Dedeilias

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Compare and contrast 5 scoring systems and their ability to predict morbidity and mortality in the cardiac patient population. 2. Identify preoperative, intraoperative, and postoperative variables when using a prospective study. 3. Describe the performance of each scoring system. Methods Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severityscoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. Results A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, c 2 = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ = 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). Conclusions CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients.

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confidence: 99%

Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study

Exarchopoulos

Charitidou

Dedeilias

et al. 2015

American Journal of Critical Care

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“…10,11 Although many factors affect a patient's length of stay in an ICU, 12,13 the longer a patient stays, the higher is the risk for mortality [14][15][16] and high utilization of services. [17][18][19] Stricker et al 20 found that although only 11% of patients admitted to an ICU stayed more than 7 days, the patients who stayed longer accounted for the use of more than 50% of ICU resources.…”

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confidence: 99%

The Going Home Initiative: Getting Critical Care Patients Home With Hospice

Lusardi

Jodka

Stambovsky

et al. 2011

Critical Care Nurse

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Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.

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“…These systems have limited applicability in cardiac surgery [7,8] and some, among them the LODS, have excluded cardiac surgery patients from their scope. This group of patients suffers from temporary side effects and pathophysiological effects of the heart-lung-machine, [9,10] which can influence the scores obtained from these systems [11]. These effects include the relatively long mechanical ventilation time needed to stabilize these patients [12,13] and postoperative sedation that limits interpretation of the Glasgow Coma Scale [14].…”

Section: Discussionmentioning

confidence: 99%

Logistic Organ Dysfunction Score (LODS), a reliable postoperative risk management score also in cardiac surgical patients?

Heldwein¹,

Badreldin²,

Dorr³

et al. 2011

Thorac cardiovasc Surg

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Background: The original Logistic Organ Dysfunction Sore (LODS) excluded cardiac surgerypatients from its target population, and the suitability of this score in cardiac surgery patients has never been tested. We evaluated the accuracy of the LODS and the usefulness of its daily measurement in cardiac surgery patients. The LODS is not a true logistic scoring system, since it does not use β-coefficients. Methods: This prospective study included all consecutive adult patients who were admitted tothe intensive care unit (ICU) after cardiac surgery between January 2007 and December 2008. The LODS was calculated daily from the first until the seventh postoperative day. Performance was assessed with Hosmer-Lemeshow (HL) goodness-offit test (calibration) and receiver operating characteristic (ROC) curves (discrimination) from ICU admission day until day 7. The outcome measure was ICU mortality.

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Predictors of Outcome in Cardiac Surgical Patients With Prolonged Intensive Care Stay

Cited by 108 publications

References 32 publications

Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study

Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study

The Going Home Initiative: Getting Critical Care Patients Home With Hospice

Logistic Organ Dysfunction Score (LODS), a reliable postoperative risk management score also in cardiac surgical patients?

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