Citation Information :
Kher V, Bhan A, Kumar M, Sethi S, Bazaz S, Sharma P. Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery. Indian J Crit Care Med 2014; 18 (10):653-658.
Background: Neonates and infants undergoing heart surgery on cardiopulmonary bypass (CPB) are at high risk for significant post-operative morbidity and mortality. Hence, there is a need to identify and quantify clinical factors during the early post-operative period that are indicative of short-term as well as long-term outcomes. Multiple inotrope scores have been used in practice to quantify the amount of cardiovascular support received by neonates.
Aims: The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcomes in children after open cardiac surgery.
Materials and Methods: This is a retrospective analysis of the 208 patients who underwent cardiac surgery for congenital heart disease at a tertiary pediatric cardiac surgery Intensive Care Unit (ICU) from January 2012 to March 2013. Multiple demographic, intra-operative and post-operative variables were recorded, including the Vasoactive Inotrope Score (VIS).
Results: A total of 208 patients underwent cardiac surgery for congenital heart disease in the study period. The mean age and weight in the study were 66.94 months and 16.31 kg, respectively. Statistically significant associations were found in the various variables and VIS, including infancy, weight < 10 kg, CPB time, pump failure and post-operative variables like sepsis, hematological complications, hepatic dysfunction, acute kidney injury during admission, mortality, prolonged ventilator requirement, CPB time (in min) and hospital stay.
Conclusions: Inotrope score and its adaptations are an excellent tool to measure illness severity, deciding interventions and during parental counseling in the pediatric cardiac surgery ICUs.
Curzon CL, Milford-Beland S, Li JS, O′Brien SM, Jacobs JP, Jacobs ML, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: Analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008;135:546-51.
Dorfman AT, Marino BS, Wernovsky G, Tabbutt S, Ravishankar C, Godinez RI, et al. Critical heart disease in the neonate: Presentation and outcome at a tertiary care center. Pediatr Crit Care Med 2008;9:193-202.
Gaynor JW, Mahle WT, Cohen MI, Ittenbach RF, DeCampli WM, Steven JM, et al. Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 2002;22:82-9.
Mahle WT, Tavani F, Zimmerman RA, Nicolson SC, Galli KK, Gaynor JW, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation 2002;106:I109-14.
McQuillen PS, Barkovich AJ, Hamrick SE, Perez M, Ward P, Glidden DV, et al. Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke 2007;38:736-41.
Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG. Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 2006;131:412-7.
Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995;92:2226-35.
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010;11:234-8.
Davidson J, Tong S, Hancock H, Hauck A, Cruz E, Kaufman J. Prospective validation of the vasoactive inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med 2012;38:1184-90.
Balaguru D, Haddock PS, Puglisi JL, Bers DM, Coetzee WA, Artman M. Role of the sarcoplasmic reticulum in contraction and relaxation of immature rabbit ventricular myocytes. J Mol Cell Cardiol 1997;29:2747-57.
Butts RJ, Scheurer MA, Atz AM, Zyblewski SC, Hulsey TC, Bradley SM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol 2012;33:633-8.
Sanil Y, Aggarwal S. Vasoactive-inotropic score after pediatric heart transplant: A marker of adverse outcome. Pediatr Transplant 2013;17:567-72.
Gaies MG, Jeffries HE, Niebler RA, Pasquali SK, Donohue JE, Yu S, et al. Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery: An Analysis From the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med 2014;15:529-37
Favia I, Vitale V, Ricci Z. The vasoactive-inotropic score and levosimendan: Time for LVIS? J Cardiothorac Vasc Anesth 2013;27:e15-6.
Sethi SK, Sharma R, Kumar M, Bazaz S, Bhan A, Kher V. Incidence and Risk Factors of Acute Kidney Injury and Mortality in Pediatric Cardiothoracic ICU: First Prospective Study from India. Proceedings of the 1 st international Symposium on AKI in Children at the 7 th International Conference on Pediatric Continuous Renal Replacement therapy; 2012 September 27-30; Ohio; USA. Pediatr Nephrol 2013;28:1379-532
Hoffman TM, Wernovsky G, Atz AM, Bailey JM, Akbary A, Kocsis JF, et al. Prophylactic intravenous use of milrinone after cardiac operation in pediatrics (PRIMACORP) study. Prophylactic intravenous use of milrinone after cardiac operation in pediatrics. Am Heart J 2002;143:15-21.
Sethi SK, Goyal D, Yadav DK, Shukla U, Kajala PL, Gupta VK, et al. Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 2011;15:529-34.