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The Total Inotrope Exposure Score: an extension of the Vasoactive Inotrope Score as a predictor of adverse outcomes after paediatric cardiac surgery

Published online by Cambridge University Press:  13 March 2017

Harish Bangalore ,
Michael Gaies ,
Elena C. Ocampo ,
Jeffrey S. Heinle ,
Danielle Guffey ,
Charles G. Minard ,
Paul Checchia  and
Lara S. Shekerdemian
Harish Bangalore
Affiliation:
Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Michael Gaies
Affiliation:
Department of Pediatrics and Communicable Diseases, Division of Cardiology, CS Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Elena C. Ocampo
Affiliation:
Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jeffrey S. Heinle
Affiliation:
Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Danielle Guffey
Affiliation:
Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States of America
Charles G. Minard
Affiliation:
Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States of America
Paul Checchia
Affiliation:
Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Lara S. Shekerdemian*
Affiliation:
Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: Dr L. S. Shekerdemian, MBChB, MD, FRACP, MHA, Chief, Critical Care-Texas Children’s Hospital, Section Head of Critical Care Medicine, Texas Children’s Hospital, Professor of Pediatrics, Baylor College of Medicine, Associate Vice-Chair of Clinical Affairs, Pediatrics, Baylor College of Medicine, 6621 Fannin St.Suite W6006, Houston, TX 77030, United States of America. Tel: 832 826 6230; Fax: 832 825 6229; E-mail: lssheker@texaschildrens.org
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Abstract

Objective

The aim of the present study was to explore and compare the association between a new vasoactive score – the Total Inotrope Exposure Score – and outcome and the established Vasoactive Inotrope Score in children undergoing cardiac surgery with cardiopulmonary bypass

Design

The present study was a single-centre, retrospective study.

Setting

The study was carried out at a 21-bed cardiovascular ICU in a Tertiary Children’s Hospital between September, 2010 and May, 2011

Methods

The Total Inotrope Exposure Score is a new vasoactive score that brings together cumulative vasoactive drug exposure and incorporates dose adjustments over time. The performance of these scores – average, maximum Vasoactive Inotrope Score at 24 and 48 hours, and Total Inotrope Exposure Score – to predict primary clinical outcomes – either death, cardiopulmonary resuscitation, or extra-corporeal membrane oxygenation before hospital discharge – and secondary outcomes – length of invasive mechanical ventilation, length of ICU stay, and hospital stay – was calculated.

Main results

The study cohort included 167 children under 18 years of age, with 37 (22.2%) neonates and 65 (41.3%) infants aged between 1 month and 1 year. The Total Inotrope Exposure Score best predicted the primary outcome (six of 167 cases) with an unadjusted odds ratio for a poor outcome of 42 (4.8, 369.6). Although the area under curve was higher than other scores, this difference did not reach statistical significance. The Total Inotrope Exposure Score best predicted prolonged invasive mechanical ventilation, length of ICU stay, and hospital stay as compared with the other scores.

Conclusion

The Total Inotrope Exposure Score appears to have a good association with poor postoperative outcomes and warrants prospective validation across larger numbers of patients across institutions.

Keywords

Inotrope scorevasoactive inotrope scoretotal inotrope exposure scorecardiac surgery children
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1146 - 1152
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Copyright
© Cambridge University Press 2017 

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Footnotes

This work was performed at Department of Pediatrics, Sections of Critical Care and Cardiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America.

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