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Oxygen delivery in pediatric cardiac surgery and its association with acute kidney injury using machine learning.
Hayward, Alice; Robertson, Alex; Thiruchelvam, Timothy; Broadhead, Michael; Tsang, Victor T; Sebire, Neil J; Issitt, Richard W.
Afiliación
  • Hayward A; Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom.
  • Robertson A; Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom.
  • Thiruchelvam T; Department of Intensive Care, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
  • Broadhead M; Department of Anesthetics, Great Ormond Street Hospital, London, United Kingdom.
  • Tsang VT; Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
  • Sebire NJ; Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom.
  • Issitt RW; Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom. Electronic addr
J Thorac Cardiovasc Surg ; 165(4): 1505-1516, 2023 04.
Article en En | MEDLINE | ID: mdl-35840430
OBJECTIVE: Acute kidney injury (AKI) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) is a frequently reported complication. In this study we aimed to determine the oxygen delivery indexed to body surface area (Do2i) threshold associated with postoperative AKI in pediatric patients during CPB, and whether it remains clinically important in the context of other known independent risk factors. METHODS: A single-institution, retrospective study, encompassing 396 pediatric patients, who underwent heart surgery between April 2019 and April 2021 was undertaken. Time spent below Do2i thresholds were compared to determine the critical value for all stages of AKI occurring within 48 hours of surgery. Do2i threshold was then included in a classification analysis with known risk factors including nephrotoxic drug usage, surgical complexity, intraoperative data, comorbidities and ventricular function data, and vasoactive inotrope requirement to determine Do2i predictive importance. RESULTS: Logistic regression models showed cumulative time spent below a Do2i value of 350 mL/min/m2 was associated with AKI. Random forest models, incorporating established risk factors, showed Do2i threshold still maintained predictive importance. Patients who developed post-CPB AKI were younger, had longer CPB and ischemic times, and required higher inotrope support postsurgery. CONCLUSIONS: The present data support previous findings that Do2i during CPB is an independent risk factor for AKI development in pediatric patients. Furthermore, the data support previous suggestions of a higher threshold value in children compared with that in adults and indicate that adjustments in Do2i management might reduce incidence of postoperative AKI in the pediatric cardiac surgery population.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxígeno / Lesión Renal Aguda / Aprendizaje Automático / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2023 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxígeno / Lesión Renal Aguda / Aprendizaje Automático / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2023 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos