Vasoactive-ventilation-renal score as a risk factor for prolonged mechanical ventilation after congenital heart surgery in pediatric patients
Medical Review (Med. pregled), 2024, 60(4), 33-41.
D. Pechilkov1, L. Simeonov1, Z. Vasileva1, V. Boshnakov2, T. Aleksandrova3, A. Kaneva1
1 Department of Pediatric Cardiology, National Heart Hospital, Sofia
2 Congenital Heart Surgery Unit, National Heart Hospital, Sofia
3 Department of Neonatology, University Obstetrics and Gynecology Hospital, Medical University, Sofia
Abstract. Introduction. Prolonged mechanical ventilation (PMV) is a well-recognized factor as a quality metric for pediatric cardiac surgical programs. Most of the risk factors for PMV are described and analyzed. Based on them, some authors had estab-lished predictive models to proactively detect patients in risk for PMV. This research aims to study vasoactive-ventilation-renal (VVR) score as a risk factor for PMV after congenital heart surgery (CHS) in pediatric patients. Methods. A retrospective single center cohort study was conducted. Medical files of patients aged 0-18 years, who underwent heart surgery in 2016 and 2017, were reviewed. The focus was on VVR score in the first 48 hours after surgery. Results. 438 patients were operated and 384 of them were included in the study. 80 (20.8%) patients needed PMV (group 1) and 304 (79.2%) did not need PMV (group 2). There was a statisti-cal significance between group 1 and group 2 concerning VVR score for the first 48 hours. The peak VVR on the day of surgery with cut-off value >38.84 (>32.4 to >44.3) has highest predictive value for PMV, with the ROC curve analysis showing AUC 0,900 (95% CI 0,860-0,940), sensitivity of 82.5% and specificity of 84.54%. Patients with VVR on the day of operation > 39 had significantly longer length of in-hospital stay and higher postoperative mortality. Conclusion. Peak VVR score at the day of surgery is a reliable factor for prediction of PMV and outcomes after CHS in pediatric patients in our center.
Key words: children, congenital heart disease, congenital heart surgery, prolonged mechanical ventilation, risk factors, VVR
Address for correspondence: Dimitar Pechilkov, MD, e-mail: pe4ilkov@gmail.com