Validation of the Vasoactive-Inotropic Score in Pediatric Sepsis*

McIntosh, Amanda; Tong, Suhong; Deakyne, Sara; Davidson, Jesse; Scott, Halden F.

doi:10.1097/pcc.0000000000001191

Cited by 207 publications

(185 citation statements)

References 24 publications

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“…This result was most likely due to later initiation of vasopressors and the impact of higher baseline weight in calculating VIS [38][39][40]. A higher VIS at 48 h after cardiovascular surgery was found to be associated with a longer ICU length of stay and longer ventilator days in pediatric sepsis patients [41]. In our study, group 4 with a lower fluid resuscitation rate and a lower VIS in the first 24 h had worse clinical outcomes.…”

Section: Discussionmentioning

confidence: 49%

Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

Chen

Dong

et al. 2020

Crit Care

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Background: Fluid resuscitation has become the cornerstone of early septic shock management, but the optimal fluid rate is still not well studied. The goal of this investigation is to examine the relationship between fluid resuscitation rate and septic shock resolution. Method: We retrospectively studied adult (≥ 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester. The fluid resuscitation time was defined as the time required to infuse the initial fluid bolus of 30 ml/kg, based on the recommendations of the 2016 surviving sepsis campaign. The cohort was divided into four groups based on the average fluid rate (group 1 ≥ 0.5, group 2 0.25-0.49, group 3 0.17-0.24, and group 4 < 0.17 ml/kg/min). The primary outcome was the time to shock reversal. Multivariable regression analyses were conducted to account for potential confounders. Result: A total of 1052 patients met eligibility criteria and were included in the analysis. The time-to-shock reversal was significantly different among the groups (P < .001). Patients in group 1 who received fluid resuscitation at a faster rate had a shorter time to shock reversal (HR = 0.78; 95% CI 0.66-0.91; P = .01) when compared with group 4 with a median (IQR) time-to-shock reversal of 1.7 (1.5, 2.0) vs. 2.8 (2.6, 3.3) days, respectively. Using 0.25 ml/kg/min as cutoff, the higher fluid infusion rate was associated with a shorter time to shock reversal (HR = 1.22; 95% CI 1.06-1.41; P = .004) and with decreased odds of 28-day mortality (HR = 0.71; 95% CI 0.60-0.85; P < .001). Conclusion: In septic shock patients, initial fluid resuscitation rate of 0.25-0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV fluid resuscitation within the first 2 h), may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion.In this study, we assess the impact of the initial fluid replacement rate on the outcome of patients with septic shock managed based on Surviving Sepsis Campaign (SSC) guidelines. We found among septic shock patients the minimum initial fluid resuscitation rate of 0.25-0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV fluid resuscitation within the first 2 h) is associated with a shorter time to shock reversal and improved patient outcome.

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Section: Discussionmentioning

confidence: 49%

Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

Chen

Dong

et al. 2020

Crit Care

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“…using the maximum dosing rates of vasoactive and inotropic medications (mg kg À1 min À1 or IU kg À1 min À1 ) during the first 24 h after postoperative ICU admission, which were retrieved from the ICU critical care information system with separate database queries. 13,19 We selected VIS max cut-off values to define five groups for an adult population instead of using values of a paediatric population. 13 Radiological imaging data were collected from our hospital radiological image archiving and communication system (Sectra, PACS, Link€ oping, Sweden).…”

Section: Data Collection Methodsmentioning

confidence: 99%

Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery

Koponen

Karttunen

Musialowicz

et al. 2019

British Journal of Anaesthesia

200

131

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Background: The vasoactive-inotropic score (VIS) predicts mortality and morbidity after paediatric cardiac surgery. Here we examined whether VIS also predicted outcome in adults after cardiac surgery, and compared predictive capability between VIS and three widely used scoring systems. Methods: This single-centre retrospective cohort study included 3213 cardiac surgery patients. Maximal VIS (VIS max ) was calculated using the highest doses of vasoactive and inotropic medications administered during the first 24 h postsurgery. We established five VIS max categories: 0e5, >5e15, >15e30, >30e45, and >45 points. The predictive accuracy of VIS max was evaluated for a composite outcome, which included 30-day mortality, mediastinitis, stroke, acute kidney injury, and myocardial infarction. Results: VIS max showed good prediction accuracy for the composite outcome [area under the curve (AUC), 0.72; 95% confidence interval (CI), 0.69e0.75]. The incidence of the composite outcome was 9.6% overall and 43% in the highest VIS max group (>45). VIS max predicted 30-day mortality (AUC, 0.76; 95% CI, 0.69e0.83) and 1-yr mortality (AUC, 0.70; 95% CI, 0.65e0.74). Prediction accuracy for unfavourable outcome was significantly better with VIS max than with Acute Physiology and Chronic Health Evaluation II (P¼0.01) and Simplified Acute Physiological Score II (P¼0.048), but not with the Sequential Organ Failure Assessment score (P¼0.32). Conclusions: In adults after cardiac surgery, VIS max predicted a composite of unfavourable outcomes and predicted mortality up to 1 yr after surgery.

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“…To our knowledge, only two studies in septic patients and in a group of pediatric patients underwent VIS (7,8). In a study, pediatric sepsis patients (2 months-18 years) in the intensive care unit were evaluated with VIS.…”

Section: Discussionmentioning

confidence: 99%

“…The vasoactive inotropic score (VIS), developed to measure vasopressor support, is mostly used in pediatric patients and cardiac surgery patients (3)(4)(5)(6). Also, two studies have used VIS in pediatric sepsis patient groups (7,8). To our best knowledge, there is no present study using VIS in adult septic shock.…”

Section: Introductionmentioning

confidence: 99%

The use of Vasoactive-Inotropic Score in Adult Patients with Septic Shock in Intensive Care

Kara¹,

Sargın²,

Bayraktar³

et al. 2019

Yoğun Bakım Derg

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Objective: Sepsis and septic shock are significant causes of mortality and morbidity. In septic shock, vasopressors and inotropic support are given for the treatment of hypotension. This study was designed to investigate the relationship between the vasoactive-inotropic score (VIS) and the results of sepsis patients in ICU. Methods: The data of 392 patients who were followed up with the diagnosis of septic shock in adult ICU were recorded retrospectively. Vasopressors and inotropic support of the patients during the first 48 hours after the diagnosis of septic shock were recorded. Mean and peak VIS values were calculated according to these values. The patients were divided into groups according to the mean VIS≥10, peak VIS≥10 and intensive care results and statistical analysis was performed. Results: The median ages of the patients were 68 (54.25-79) years and 239 (61%) were male. Dopamine 188 (47.9%), noradrenaline 365 (93.1%), adrenaline 53 (13.5%) and dobutamine 15 (3.8%) were used in the patients. The mean VIS was 9 (4-15), while the number of mean VIS≥10 patients were 192 (49%). Peak VIS values were 11 (5-20), and the number of peak VIS ≥10 patients were 220 (56.1%). The mortality rate of the patients included in the study was 42.1%. The mean VIS score(13 vs 6, p=0.000), mean VIS≥10 patient ratio (71.5% vs 32.6%, p=0.000), peak VIS score (16 vs 8, p=0.000), and peak VIS ≥10 patient ratio (73.3% vs 43.6%, p=0.000) were higher in non-survivors. The parameters such as mean VIS [OR 1.123, 95% CI 1.027-1.229, p=0.011], mean VIS≥10 [OR 3.455, 95% CI 1.625-7.345, p=0.001] and peak VIS score [OR 0.917, 95% CI 0.851-0.989, p=0.024] were determined as independent risk factors for mortality. Conclusion: We conclude that vasoactive-inotropic score may be useful in predicting the outcome of septic shock patients in intensive care units.

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Validation of the Vasoactive-Inotropic Score in Pediatric Sepsis*

Cited by 207 publications

References 24 publications

Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery

The use of Vasoactive-Inotropic Score in Adult Patients with Septic Shock in Intensive Care

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