TY - JOUR
T1 - Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery
AU - Cantinotti, Massimiliano
AU - Giordano, Raffaele
AU - Scalese, Marco
AU - Marchese, Pietro
AU - Franchi, Eliana
AU - Viacava, Cecilia
AU - Molinaro, Sabrina
AU - Assanta, Nadia
AU - Koestenberger, Martin
AU - Kutty, Shelby
AU - Gargani, Luna
AU - Ait-Ali, Lamia
N1 - Funding Information:
This work was supported by the Italian Health Ministry Finalized Research Young Research Award 2013, project no. GR-2013-02358631.
Funding Information:
We have demonstrated the prognostic value of LUS score as an independent predictor for ICU LOS and ET after pediatric cardiac surgery. Although the anterior assessment has been shown to be less sensitive in the diagnosis of effusion or atelectasis, 5 it seems to have a greater prognostic benefit. Therefore, even a quick LUS examination limited to anterior and lateral areas may provide important prognostic information. Further and larger studies are required to validate and reinforce these data. This work was supported by the Italian Health Ministry Finalized Research Young Research Award 2013, project no. GR-2013-02358631 .
Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/1
Y1 - 2020/1
N2 - Background: Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C. Methods: LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time. Results: The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007). Conclusions: Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.
AB - Background: Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C. Methods: LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time. Results: The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007). Conclusions: Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.
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U2 - 10.1016/j.athoracsur.2019.06.057
DO - 10.1016/j.athoracsur.2019.06.057
M3 - Article
C2 - 31400328
AN - SCOPUS:85074343499
VL - 109
SP - 178
EP - 184
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -