About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

A.E. Bautin, A.V. Ksendikova, S.S. Belolipetskiy, N.R. Abutalimova, A.O. Marichev, A.V. Naimushin, V.L. Etin, A.M. Radovskiy, L.I. Karpova, V.K. Grebennik, M.L. Gordeev

Almazov National Medical Research Centre, St. Petersburg

For correspondence: Andrei E. Bautin, MD. PhD, Head of research division in anesthesiology and intensive care, Almazov National Medical Research Centre, St. Petersburg; e-mail: abautin@mail.ru, tel. +79217539110

For citation: Bautin AE, Ksendikova AV, Belolipetskiy SS, Abutalimova NR, Marichev AO, Naimushin AV, Etin VL, Radovskiy AM, Karpova LI, Grebennik VK, Gordeev ML. About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery. Alexander Saltanov Intensive Care Herald. 2019;2:66–74.

DOI: 10.21320/1818-474X-2019-2-66-74

Pharmacological scores, such as inotropic score (IS) and vasoactive-inotropic score (VIS) were created to quantify doses of vasoactive and inotropic drugs. The number of studies where IS and VIS were used for evaluation of postoperative period of adult patients after cardiac surgery is small.

Objective: to estimate IS and VIS as an approach for monitoring of the hemodynamic profile and clinical outcomes in the early postoperative period of cardiac surgery.

Methods. The study involved 144 patients older than 18 years who underwent cardiac surgery under cardiopulmonary bypass (CPB). In perioperative period we measured cardiac output using a Swan-Ganz catheter with the calculation of central hemodynamic parameters, and also VIS and IS wcre calculated. We evaluated the prognostic value of these pharmacological scores in the development of complications of the early postoperative period, as well as their correlation with the duration of respiratory support, the length of stay in the ICU, and total hospital time.

Results. IS ≥ 10 significantly associated with prolonged respiratory support, a long stay in the ICU and with a mortality rate of 28.6 %. Patients with IS ≥ 10 are characterized by a violation of tissue perfusion, main cause of which may be a low cardiac output syndrome. IS ≥ 10 can be used as criteria for the low cardiac output syndrome with impaired organ perfusion. The use of this pharmacological score as a predictor of adverse clinical outcomes and increased mortality is justified. The hemodynamic profile of patients with VIS ≥ 10 is characterized by the absence of signs of cardiac output decrease and normal organ perfusion. It has low prognostic significance for the adverse postoperative clinical outcomes and should not be used as perioperative criteria for low cardiac output. In addition, VIS ≥ 10 requires careful use as a predictor of adverse postoperative outcomes and mortality.

Keywords: Vasoactive-inotropic score, inotropic score, cardiac surgery, cardiopulmonary bypass, low cardiac output syndrome, vasoplegia syndrome, perioperative period, cardiac anesthesiology

Received: 11.03.2019


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