期刊论文详细信息
BMC Anesthesiology
Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence, outcomes and predictors
Nandor Marczin1  Faiz Ramjankhan2  Albert Huisman3  Eric E. C. de Waal4  Wilton A. van Klei4  Bas van Zaane4  Marnix M. van der Schoot5 
[1] Anaesthesiologist, Section of Anaesthesia, Pain Medicine and Intensive Care, Imperial College;Cardiothoracic surgeon, Department of Cardiothoracic Surgery, University Medical Centre Utrecht;Clinical chemist, Department of Clinical Chemistry and Hematology, University Medical Centre Utrecht;Department of Anesthesiology, University Medical Centre Utrecht, Mailstop Q04.2.317;Medical student, Faculty of Medicine, Utrecht University;
关键词: Cardiac Vasoplegia syndrome;    Mechanical circulatory support;    Incidence;    Outcome;    Morbidity;    Mortality;   
DOI  :  10.1186/s12871-018-0645-y
来源: DOAJ
【 摘 要 】

Abstract Background Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients. Methods Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006–2013) and a temporal validation cohort (n = 73, 2014–2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48 h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC). Results The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 [6.9–20.8] vs 6.1 [4.6–10.4] p = 0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9–18.2) and one-year-mortality (OR 3.9, 95% CI 1.5–10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8–10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71–0.89, p <  0.01). Temporal validation resulted in an AUC of 0.74 (95% CI 0.61–0.87, p <  0.01). Conclusions In the era of the new generation of cfLVADs, vasoplegia remains a prevalent (33%) and critical condition with worse short-term outcomes and survival. We identified previous cardiothoracic surgery, preoperative treatment with dopamine, preoperative bilirubin levels and preoperative creatinine clearance as independent predictors.

【 授权许可】

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