Optimizing Care of Adults With Congenital Heart Disease in a Pediatric Cardiovascular ICU Using Electronic Clinical Decision Support*

May, Lindsay J.; Longhurst, Chris; Pageler, Natalie M.; Wood, Matthew; Sharek, Paul J.; Zebrack, C. Michelle

doi:10.1097/pcc.0000000000000124

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…The patients included in this study reflect the postoperative patient populations at many centers, where adults undergoing surgery for congenital heart disease are commonly cared for within pediatric cardiovascular ICUs. 12,13 The greater heterogeneity of the patient population in this study has increased the strength and practicality of the VVR.…”

Section: Discussionmentioning

confidence: 99%

Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Scherer

Moser

Brown

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: We aimed to further validate the vasoactive-ventilation-renal score as a predictor of outcome in patients recovering from surgery for congenital heart disease. We also sought to determine the optimal time point within the early recovery period at which the vasoactive-ventilation-renal score should be measured. Methods: We prospectively reviewed consecutive patients recovering from cardiac surgery within our intensive care unit between January 2015 and June 2015. The vasoactive-ventilation-renal score was calculated at 6, 12, 24, and 48 hours postoperatively as follows: vasoactive-ventilation-renal score ¼ ventilation index þ vasoactive-inotrope score þ D creatinine [change in serum creatinine from baseline*10]. Primary outcome of interest was prolonged hospital length of stay, defined as length of stay in the upper 25%. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling also was performed. Results: We reviewed 164 patients with a median age of 9.25 months (interquartile range, 2.6-58 months). Median length of stay was 8 days (interquartile range, 5-17.5 days). The area under the curve value for the vasoactive-ventilation-renal score as a predictor of prolonged length of stay (>17.5 days) was greatest at 12 hours postoperatively (area under the curve ¼ 0.93; 95% confidence interval, 0.89-0.97). On multivariable regression analysis, after adjustment for potential confounders, the 12-hour vasoactive-ventilation-renal score remained a strong predictor of prolonged hospital length of stay (odds ratio, 1.15; 95% confidence interval, 1.10-1.20). Conclusions: In a heterogeneous population of patients undergoing surgery for congenital heart disease, the novel vasoactive-ventilation-renal score calculated in the early postoperative recovery period can be a strong predictor of prolonged hospital length of stay.

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Section: Discussionmentioning

confidence: 99%

Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Scherer

Moser

Brown

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…Table 1 summarizes and shows the characteristics of the studies. Fourteen studies evaluated the functionality of CDSSs in ICUs [51][52][53][54][55][56][57][58][59][60][61][62][63][64], three examined the applicability of databases in ICUs [65][66][67], one studied investigated the usefulness of EHRs [68], and another one considered CPOE [69]. Lastly, three analyzed the function of combinations of CDSS/CPOE and CDSS/EHR [70][71][72].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fifteen studies involved patients over 18 years [51][52][53][54][55][57][58][59]61,[64][65][66][67][68][69], five studies focused on pediatric patients [56,63,[70][71][72], one used data from both populations [62], and examined professionals [60]. Most studies were conducted in the United States [51,52,55,56,58,62,[65][66][67][68], Germany [64,72], and the United Kingdom [53,59,63]. Moreover, one was developed each in Spain [69], Israel [71], France [70], Australia [60], Sweden [61], Japan [54], and Canada [57].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The publication dates of these studies ranged from 2006 to 2018. Seven studies focused on the development and validation of information systems [51,53,57,59,64,66,72], five studies used retrospective analysis [52,55,56,58,67], three were prospective cohort studies [63,69,71], two studies conducted had an experimental design [60,65], and one was a controlled trial [54,61]; the remaining were a performance study [70], a multicenter study [62], and an observational cohort study [68].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies analyzed the incorporation of CDSSs into surveillance and continuous analysis to allow the fast detection of clinical alterations [51,58,65,72]. Two studies examined the use of CDSSs in cardiac surgery patients.…”

Section: Warning Systems: Early Detection and Early Actionmentioning

confidence: 99%

See 2 more Smart Citations

Applicability of Clinical Decision Support in Management among Patients Undergoing Cardiac Surgery in Intensive Care Unit: A Systematic Review

et al. 2021

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The advances achieved in recent decades regarding cardiac surgery have led to a new risk that goes beyond surgeons' dexterity; postoperative hours are crucial for cardiac surgery patients and are usually spent in intensive care units (ICUs), where the patients need to be continuously monitored to adjust their treatment. Clinical decision support systems (CDSSs) have been developed to take this real-time information and provide clinical suggestions to physicians in order to reduce medical errors and to improve patient recovery. In this review, an initial total of 499 papers were considered after identification using PubMed, Web of Science, and CINAHL. Twenty-two studies were included after filtering, which included the deletion of duplications and the exclusion of titles or abstracts that were not of real interest. A review of these papers concluded the applicability and advances that CDSSs offer for both doctors and patients. Better prognosis and recovery rates are achieved by using this technology, which has also received high acceptance among most physicians. However, despite the evidence that well-designed CDSSs are effective, they still need to be refined to offer the best assistance possible, which may still take time, despite the promising models that have already been applied in real ICUs.

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General Intensive Care Monitoring and Management

Sanchez‐de‐Toledo

Sáenz

Pereda³

2019

Intensive Care of the Adult With Congenital Heart Disease

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Optimizing Care of Adults With Congenital Heart Disease in a Pediatric Cardiovascular ICU Using Electronic Clinical Decision Support*

Cited by 11 publications

References 18 publications

Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Applicability of Clinical Decision Support in Management among Patients Undergoing Cardiac Surgery in Intensive Care Unit: A Systematic Review

General Intensive Care Monitoring and Management

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