Alyaa Ahdy Abdelaziz, Fady Mohammed ElGendy, Alaa Atef Hegazy, Mai Hussein, Ramy Mohamed Ghazy
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Results The most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications ( AUC = 85.5%), followed by ScvO2/lactate ( AUC = 83.0%), lactate level 12 h after admission ( AUC = 75.0%), MAP ( AUC = 73.6%), and VIS ( AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications ( OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and ( OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively. Conclusions To predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission. The Cochrane TRN PACTR202104905893217. Date of registration 12 April 2021.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.5000,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic value of combined central venous oxygen saturation and lactate in pediatric patients after cardiac surgery\",\"authors\":\"Alyaa Ahdy Abdelaziz, Fady Mohammed ElGendy, Alaa Atef Hegazy, Mai Hussein, Ramy Mohamed Ghazy\",\"doi\":\"10.1186/s43054-023-00230-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Abstract Objectives This study assessed the value of measuring both arterial lactate levels and central venous oxygen saturation (ScvO2) in predicting cardiac surgery outcomes in pediatric patients. Methods A prospective cohort study was conducted on 73 patients who underwent surgery for congenital heart disease. Vasoactive-inotropic score (VIS), serial mean arterial blood pressures (MAP), lactate levels, and ScvO 2 were measured immediately and 3, 6, 12, 18, and 24 h after admission to the pediatric intensive care unit (PICU). To test the prognostic values of these markers, we calculated the areas under the receiver operating characteristic curves (AUCs). Binary logistic regression was used to identify the determinants of postsurgical complications. Results The most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications ( AUC = 85.5%), followed by ScvO2/lactate ( AUC = 83.0%), lactate level 12 h after admission ( AUC = 75.0%), MAP ( AUC = 73.6%), and VIS ( AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications ( OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and ( OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively. Conclusions To predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission. The Cochrane TRN PACTR202104905893217. 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引用次数: 0
摘要
目的本研究评估动脉乳酸水平和中心静脉氧饱和度(ScvO2)在预测儿科心脏手术患者预后中的价值。方法对73例先天性心脏病手术患者进行前瞻性队列研究。在儿童重症监护病房(PICU)入院后立即及3、6、12、18和24小时测量血管活性-肌力评分(VIS)、连续平均动脉血压(MAP)、乳酸水平和ScvO 2。为了检验这些标志物的预后价值,我们计算了受试者工作特征曲线(auc)下的面积。二元逻辑回归用于确定术后并发症的决定因素。结果心脏手术后最常见的并发症为机械通气时间延长(38.36%)、胸部感染(30.14%)、PICU住院时间延长(24.66%)和脓毒症(9.59%)。入院后6 h ScvO2最能预测并发症(AUC = 85.5%),其次是ScvO2/乳酸(AUC = 83.0%)、入院后12 h乳酸水平(AUC = 75.0%)、MAP (AUC = 73.6%)和VIS (AUC = 63.4)。在多因素分析中,体重和入PICU后6 h ScvO2是并发症的主要预测因素(OR = 0.01, 95% CI 0.001 ~ 0.689, p = 0.033)和(OR = 0.87, 95% CI 0.798 ~ 0.948, p = 0.002)。结论为了预测小儿心脏手术后的并发症,入院后6小时的ScvO2测量并没有增加测量乳酸的价值。Cochrane TRN PACTR202104905893217。注册日期2021年4月12日。
Prognostic value of combined central venous oxygen saturation and lactate in pediatric patients after cardiac surgery
Abstract Objectives This study assessed the value of measuring both arterial lactate levels and central venous oxygen saturation (ScvO2) in predicting cardiac surgery outcomes in pediatric patients. Methods A prospective cohort study was conducted on 73 patients who underwent surgery for congenital heart disease. Vasoactive-inotropic score (VIS), serial mean arterial blood pressures (MAP), lactate levels, and ScvO 2 were measured immediately and 3, 6, 12, 18, and 24 h after admission to the pediatric intensive care unit (PICU). To test the prognostic values of these markers, we calculated the areas under the receiver operating characteristic curves (AUCs). Binary logistic regression was used to identify the determinants of postsurgical complications. Results The most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications ( AUC = 85.5%), followed by ScvO2/lactate ( AUC = 83.0%), lactate level 12 h after admission ( AUC = 75.0%), MAP ( AUC = 73.6%), and VIS ( AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications ( OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and ( OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively. Conclusions To predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission. The Cochrane TRN PACTR202104905893217. Date of registration 12 April 2021.
期刊介绍:
The Gazette is the official journal of the Egyptian Pediatric Association. The main purpose of the Gazette is to provide a place for the publication of high-quality papers documenting recent advances and new developments in both pediatrics and pediatric surgery in clinical and experimental settings. An equally important purpose of the Gazette is to publish local and regional issues related to children and child care. The Gazette welcomes original papers, review articles, case reports and short communications as well as short technical reports. Papers submitted to the Gazette are peer-reviewed by a large review board. The Gazette also offers CME quizzes, credits for which can be claimed from either the EPA website or the EPA headquarters. Fields of interest: all aspects of pediatrics, pediatric surgery, child health and child care. The Gazette complies with the Uniform Requirements for Manuscripts submitted to biomedical journals as recommended by the International Committee of Medical Journal Editors (ICMJE).