Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

Kontar, Loay; Beaubien-Souligny, William; Couture, Étienne J.; Jacquet-Lagrèze, Matthias; Lamarche, Yoan; Lévesque, Sylvie; Babin, Denis; Denault, André

doi:10.1371/journal.pone.0285526

Cited by 4 publications

(1 citation statement)

References 57 publications

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“…Prolonged cardiovascular drug therapy is frequently administered following cardiac surgery with CPB. Severe left ventricular systolic failure, preoperative PH, and postoperative FO have been reported as risk factors [ 23 ]. Furthermore, cardiogenic pulmonary edema due to FO following cardiac surgery is recognized as a cause of AKI, subsequent respiratory complications, and pulmonary hypertension, and it is associated with increased mortality rates [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Analysis of Predictors for Inhaled Nitric Oxide Therapy Administration Time Post Congenital Heart Disease Surgery: A Single-Center Observational Study

Niiyama,

Nakashima,

Ueno

et al. 2024

Cureus

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Background Congenital heart disease (CHD) is a structural deformity of the heart present at birth. Pulmonary hypertension (PH) may arise from increased blood flow to the lungs, persistent pulmonary arterial pressure elevation, or the use of cardiopulmonary bypass (CPB) during surgical repair. Inhaled nitric oxide (iNO) selectively reduces high blood pressure in the pulmonary vessels without lowering systemic blood pressure, making it useful for treating children with postoperative PH due to heart disease. However, reducing or stopping iNO can exacerbate postoperative PH and hypoxemia, necessitating long-term administration and careful tapering. This study aimed to evaluate, using machine learning (ML), factors that predict the need for long-term iNO administration after open heart surgery in CHD patients in the postoperative ICU, primarily for PH management. Methods We used an ML approach to establish an algorithm to predict 'patients with long-term use of iNO' and validate its accuracy in 34 pediatric postoperative open heart surgery patients who survived and were discharged from the ICU at Kagoshima University Hospital between April 2016 and March 2019. All patients were started on iNO therapy upon ICU admission. Overall, 16 features reflecting patient and surgical characteristics were utilized to predict the patients who needed iNO for over 168 hours using ML analysis with AutoGluon. The dataset was randomly classified into training and test cohorts, comprising 80% and 20% of the data, respectively. In the training cohort, the ML model was constructed using the important features selected by the decrease in Gini impurity and a synthetic oversampling technique. In the testing cohort, the prediction performance of the ML model was evaluated by calculating the area under the receiver operating characteristics curve (AUC) and accuracy. Results Among 28 patients in the training cohort, five needed iNO for over 168 hours; among six patients in the testing cohort, one needed iNO for over 168 hours. CPB, aortic clamp time, in-out balance, and lactate were the four most important features for predicting the need for iNO for over 168 hours. In the training cohorts, the ML model achieved perfect classification with an AUC of 1.00. In the testing cohort, the ML model also achieved perfect classification with an AUC of 1.00 and an accuracy of 1.00. Conclusion The ML approach identified that four factors (CPB, in-out balance, aortic cross-clamp time, and lactate) are strongly associated with the need for long-term iNO administration after open heart surgery in CHD patients. By understanding the outcomes of this study, we can more effectively manage iNO administration in postoperative open heart surgery in CHD patients with PH, potentially preventing the recurrence of postoperative PH and hypoxemia, thereby contributing to safer patient management.

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Section: Discussionmentioning

confidence: 99%

Machine Learning Analysis of Predictors for Inhaled Nitric Oxide Therapy Administration Time Post Congenital Heart Disease Surgery: A Single-Center Observational Study

Niiyama,

Nakashima,

Ueno

et al. 2024

Cureus

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The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery

Velho,

Pereira,

Guerra

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Postoperative organ dysfunction is common after cardiac surgery, particularly when cardiopulmonary bypass is used. The Sequential Organ Failure Assessment (SOFA) score is validated to predict morbidity and mortality in cardiac surgery. However, the impact of cardiopulmonary bypass duration on postoperative SOFA remains unclear. METHODS Retrospective study. Categorical values are presented as percentages. The comparison of SOFA groups utilized the Kruskal-Wallis chi-squared test, complemented by ad-hoc Dunn’s test with Bonferroni correction. Multinomial logistics regressions were employed to evaluate the relationship between cardiopulmonary bypass time and SOFA. RESULTS 1032 patients were included. Cardiopulmonary bypass time was independently associated with higher postoperative SOFA scores at 24 h. Cardiopulmonary bypass time was significantly higher in patients with SOFA 4–5 (**P = 0.0022) or higher (***P < 0.001) when compared to SOFA 0–1. The percentage of patients with no/mild dysfunction decreased with longer periods of cardiopulmonary bypass, down to 0% for cardiopulmonary bypass time >180min (50% of the patients with >180min of cardiopulmonary bypass presented SOFA ≥ 10). The same trend is observed for each of the SOFA variables, with higher impact in the cardiovascular and renal systems. Severe dysfunction occurs especially >200min of cardiopulmonary bypass (cardiovascular system >100min; other systems mainly >200 min). CONCLUSIONS Cardiopulmonary bypass time may predict the probability of postoperative SOFA categories. Patients with extended cardiopulmonary bypass durations exhibited higher SOFA scores (overall and for each variable) at 24 h, with higher proportion of moderate and severe dysfunction with increasing times of cardiopulmonary bypass.

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Incidence, factors, and prognostic analyses of challenging cardiopulmonary bypass separation in Chinese cardiac surgical populations

CHEN,

WANG,

XIONG

et al. 2024

Minerva Anestesiol

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Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

Cited by 4 publications

References 57 publications

Machine Learning Analysis of Predictors for Inhaled Nitric Oxide Therapy Administration Time Post Congenital Heart Disease Surgery: A Single-Center Observational Study

Machine Learning Analysis of Predictors for Inhaled Nitric Oxide Therapy Administration Time Post Congenital Heart Disease Surgery: A Single-Center Observational Study

The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery

Incidence, factors, and prognostic analyses of challenging cardiopulmonary bypass separation in Chinese cardiac surgical populations

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