Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery.

Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. Multicenter retrospective cohort study. Three pediatric cardiac ICUs at tertiary academic children's hospitals. Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. None. Postoperative patients were identified who successfully weaned off initial vasoactive infusions ( During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.

Informations de copyright

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Déclaration de conflit d'intérêts

Drs. Goldsmith, Nadkarni, Futterman, Gazit, and Salvin are co-investigators (subcontract) on the National Institutes of Health (NIH) Small Business Innovation Research (SBIR) Grant: Risk Assessment Using Noninvasive Measurements in Postoperative Pediatric Patients (NIH; National Heart, Lung, and Blood Institute; and SBIR program [2R44HL117340-03A1/04/05]). Dr. Baronov is one of the founders and the Chief Technology Officer of Etiometry, the company that created the inadequate delivery of oxygen index. He was heavily involved in the index’s development and also owns shares in the company. Dr. Tomczak is an employee of Etiometry. He was heavily involved in the index’s development and also owns shares in the company. Dr. Laussen is a lead developer of the T3 platform, which is owned by Boston Children’s Hospital, Boston, MA, and licensed to Etiometry, Boston, MA; he has received royalties from Boston Children’s Hospital following deployment of the T3 platform; he serves an advisor to Etiometry, for which he has received options in the company; and he is the co-developer of the Inadequate Oxygen Index displayed on the T3 platform.