Dataset Information

Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.

ABSTRACT: Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery.Secondary analysis of prospectively collected data from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart surgery to explore the association of DMV with perioperative transfusion and other variables.Tertiary pediatric hospital.Two hundred seventy infants undergoing two ventricle corrective cardiac surgery without aortic arch reconstruction.In univariable analyses, longer DMV was associated with younger age and lower weight at surgery, diagnostic group, and higher intraoperative and postoperative blood product transfusion (each p < .001). In multivariable proportional hazard regression, longer total support time and greater intraoperative and early postoperative blood products per kg were the strongest predictors of longer DMV. Patients in the highest tertile of intraoperative blood products per kg had an instantaneous risk of being extubated approximately half that of patients in the lowest tertile (hazard ratio, 0.51; 95% confidence interval, 0.35, 0.73). Patients who received any blood products on postoperative day 1, compared with those who did not, had a hazard ratio for extubation of 0.65 (95% confidence interval, 0.50, 0.85).In this exploratory secondary analysis of infants undergoing two ventricular repair of congenital heart disease without aortic arch obstruction, greater intraoperative and early postoperative blood transfusion emerged as potential important risk factors for longer DMV. Future prospective clinical trials are needed to determine whether reduction in blood product administration hastens postoperative recovery after infant heart surgery.

SUBMITTER: Kipps AK

PROVIDER: S-EPMC3697008 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.

Kipps Alaina K AK Wypij David D Thiagarajan Ravi R RR Bacha Emile A EA Newburger Jane W JW

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20110101 1

<h4>Objective</h4>Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery.<h4>Design</h4>Secondary analysis of prospectively collected data from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart ...[more]

PMID: 20453699

Similar Datasets

Project description:PurposeProlonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications.MethodsFour thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored.ResultsProlonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications.ConclusionIn this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors.Study registrationwww.Clinicaltrialsgov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial.

Project description:BackgroundThis research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR).MethodsThe clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h).ResultsThe mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4-574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio (OR PMV≥24) = 1.045, p = 0.005; OR PMV≥48 = 1.060, p = 0.002; OR PMV≥72 = 1.051, p = 0.011]. pRBC transfusion (OR PMV≥24 = 1.156, p = 0.001; OR PMV≥48 = 1.156, p < 0.001; OR PMV≥72 = 1.135, p ≤ 0.001) and PC transfusion (OR PMV≥24 = 1.366, p = 0.029; OR PMV≥48 = 1.226, p = 0.030; OR PMV≥72 = 1.229, p = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [OR PMV≥48 = 0.999, 95% confidence interval (CI) 0.998-1.000, p = 0.039; OR PMV≥72 = 0.999, 95% CI: 0.998-1.000, p = 0.025].ConclusionsIn patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.

Project description:RationaleDuration of mechanical ventilation is associated with adverse outcomes in critically ill patients and increased use of resources. The increasing complexity of medication regimens has been associated with increased mortality, length of stay, and fluid overload but has never been studied specifically in the setting of mechanical ventilation.ObjectiveThe purpose of this analysis was to develop prediction models for mechanical ventilation duration to test the hypothesis that incorporating medication data may improve model performance.MethodsThis was a retrospective cohort study of adults admitted to the ICU and undergoing mechanical ventilation for longer than 24 hours from October 2015 to October 2020. Patients were excluded if it was not their index ICU admission or if the patient was placed on comfort care in the first 24 hours of admission. Relevant patient characteristics including age, sex, body mass index, admission diagnosis, morbidities, vital signs measurements, severity of illness, medication regimen complexity as measured by the MRC-ICU, and medical treatments before intubation were collected. The primary outcome was area under the receiver operating characteristic (AUROC) of prediction models for prolonged mechanical ventilation (defined as greater than 5 days). Both logistic regression and supervised learning techniques including XGBoost, Random Forest, and Support Vector Machine were used to develop prediction models.ResultsThe 318 patients [age 59.9 (SD 16.9), female 39.3%, medical 28.6%] had mean 24-hour MRC-ICU score of 21.3 (10.5), mean APACHE II score of 21.0 (5.4), mean SOFA score of 9.9 (3.3), and ICU mortality rate of 22.6% (n=72). The strongest performing logistic model was the base model with MRC-ICU added, with AUROC of 0.72, positive predictive value (PPV) of 0.83, and negative prediction value (NPV) of 0.92. The strongest overall model was Random Forest with an AUROC of 0.78, a PPV of 0.53, and NPV of 0.90. Feature importance analysis using support vector machine and Random Forest revealed severity of illness scores and medication related data were the most important predictors.ConclusionsMedication regimen complexity is significantly associated with prolonged duration of mechanical ventilation in critically ill patients, and prediction models incorporating medication information showed modest improvement in this prediction.

Project description:IntroductionAcute kidney injury (AKI) is associated with high mortality rates. New biomarkers that can identify subjects with early AKI (before the increase in serum creatinine) are needed to facilitate appropriate treatment. The purpose of this study was to test the role of serum cytokines as biomarkers for AKI and prolonged mechanical ventilation.MethodsThis was a case-control study of children undergoing cardiac surgery. AKI was defined as a 50% increase in serum creatinine from baseline within 3 days. Levels of serum interleukin (IL)-1beta, IL-5, IL-6, IL-8, IL-10, IL-17, interferon (IFN)-gamma, tumor necrosis factor-alpha (TNF-alpha), granulocyte colony-stimulating factor (G-CSF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured using a bead-based multiplex cytokine kit in conjunction with flow-based protein detection and the Luminex LabMAP multiplex system in 18 cases and 21 controls. Levels of IL-6 and IL-8 were confirmed with single-analyte ELISA; IL-18 was also measured with single-analyte ELISA.ResultsIL-6 levels at 2 and 12 hours after cardiopulmonary bypass (CPB) and IL-8 levels at 2, 12 and 24 hours were associated with the development of AKI using the Wilcoxon rank-sum test and after adjustment for age, gender, race, and prior cardiac surgery in multivariate logistic regression analysis. In patients with AKI, IL-6 levels at 2 hours had excellent predictive value for prolonged mechanical ventilation (defined as mechanical ventilation for more than 24 hours postoperatively) by receiver operator curve (ROC) analysis, with an area under the ROC curve of 0.95. IL-8 levels at 2 hours had excellent predictive value for prolonged mechanical ventilation in all patients. Serum IL-18 levels were not different between those with and without AKI.ConclusionsSerum IL-6 and IL-8 values identify AKI early in patients undergoing CPB surgery. Furthermore, among patients with AKI, high IL-6 levels are associated with prolonged mechanical ventilation, suggesting that circulating cytokines in patients with AKI may have deleterious effects on other organs, including the lungs.

Project description:BACKGROUND:Weaning post-cardiac surgery patients from mechanical ventilation (MV) poses a big challenge to these patients. Optimized left ventricular-arterial coupling (VAC) may be crucial for reducing the MV duration of these patients. However, there is no research exploring the relationship between VAC and the duration of MV. We performed this study to investigate the relationship between left ventricular-arterial coupling (VAC) and prolonged mechanical ventilation (MV) in severe post-cardiac surgery patients. METHODS:This was a single-center retrospective study of 56 severe post-cardiac surgery patients from January 2015 to December 2017 at the Department of Critical Care Medicine of Peking Union Medical College Hospital. Patients were divided into two groups according to the duration of MV (PMV group: prolonged mechanical ventilation group, MV >?6?days; Non-PMV group: non-prolonged mechanical ventilation group, MV???6?days). Hemodynamics and tissue perfusion data were collected or calculated at admission (T0) and 48?h after admission (T1) to the ICU. RESULTS:In terms of hemodynamic and tissue perfusion data, there were no differences between the two groups at admission (T0). Compared with the non-prolonged MV group after 48?h in the ICU (T1), the prolonged MV group had significantly higher values for heart rate (108?±?13 vs 97?±?12, P?=?0.018), lactate (2.42?±?1.24 vs.1.46?±?0.58, P?<?0.001), and Ea/Ees (5.93?±?1.81 vs. 4.05?±?1.20, P?<?0.001). Increased Ea/Ees (odds ratio, 7.305; 95% CI, 1.181-45.168; P?=?0.032) and lactate at T1 (odds ratio, 17.796; 95% CI, 1.377-229.988; P?=?0.027) were independently associated with prolonged MV. There was a significant relationship between Ea/EesT1 and the duration of MV (r?=?0.512, P?<?0.01). The area under the receiver operating characteristic (AUC) of the left VAC for predicting prolonged MV was 0.801, and the cutoff value for Ea/Ees was 5.12, with 65.0% sensitivity and 90.0% specificity. CONCLUSIONS:Left ventricular-arterial coupling was associated with prolonged mechanical ventilation in severe post-cardiac surgery patients. The assessment and optimization of left VAC might be helpful in reducing duration of MV in these patients.

Dataset Information

Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.

Publications

Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets