Paediatric anaesthesia · 2026
A Novel Preoperative Risk Score Incorporating Non-Invasive Hemodynamics to Predict Prolonged Mechanical Ventilation in Infants Undergoing VSD Repair.
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Wang Shuangxing, Li Mingwei, Meng Bing, Wu Yongjie, Zhang Hongtao, Wei Dan, Zhang Hui, Diao Mei
Аннотация
BACKGROUND: Infants with ventricular septal defect (VSD) and concurrent respiratory compromise exhibit significant heterogeneity in their recovery after surgical repair. Objective tools for preoperative risk stratification are lacking.
AIMS: The primary aim of this study was to determine if preoperative hemodynamic data, acquired noninvasively using Electrical Cardiometry (EC), could predict prolonged mechanical ventilation (PMV) in infants undergoing VSD repair.
METHODS: We conducted a retrospective study of 51 infants. EC monitoring (ICON) was performed from admission to the day before surgery. A composite risk score was developed using Principal Component Analysis (PCA) of clinical characteristics and EC-derived hemodynamic parameters. The predictive performance of this score for PMV (defined as ≥ 12 h) was assessed using correlation and receiver operating characteristic (ROC) curve analysis. Leave-One-Out Cross-Validation (LOOCV) was used to assess the model's stability.
RESULTS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the change in the Index of Contractility (∆ICON) were identified as key parameters correlating with clinical classifications of cardiac dysfunction (r = 1.517 and 1.470, OR = 4.560 and 4.350 respectively, p < 0.05). A PCA-derived composite score was identified as a potential predictor of PMV with r = -0.522 in correlation (p < 0.001) and AUC = 0.856 (SE = 0.857, SP = 0.773, LOOCV AUC = 0.830), outperforming individual clinical variables alone.
CONCLUSIONS: A composite risk score integrating individual data and EC hemodynamics monitoring can effectively identify infants at high risk for PMV following VSD repair. This approach may provide a valuable tool for perioperative management and resource allocation.
AIMS: The primary aim of this study was to determine if preoperative hemodynamic data, acquired noninvasively using Electrical Cardiometry (EC), could predict prolonged mechanical ventilation (PMV) in infants undergoing VSD repair.
METHODS: We conducted a retrospective study of 51 infants. EC monitoring (ICON) was performed from admission to the day before surgery. A composite risk score was developed using Principal Component Analysis (PCA) of clinical characteristics and EC-derived hemodynamic parameters. The predictive performance of this score for PMV (defined as ≥ 12 h) was assessed using correlation and receiver operating characteristic (ROC) curve analysis. Leave-One-Out Cross-Validation (LOOCV) was used to assess the model's stability.
RESULTS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the change in the Index of Contractility (∆ICON) were identified as key parameters correlating with clinical classifications of cardiac dysfunction (r = 1.517 and 1.470, OR = 4.560 and 4.350 respectively, p < 0.05). A PCA-derived composite score was identified as a potential predictor of PMV with r = -0.522 in correlation (p < 0.001) and AUC = 0.856 (SE = 0.857, SP = 0.773, LOOCV AUC = 0.830), outperforming individual clinical variables alone.
CONCLUSIONS: A composite risk score integrating individual data and EC hemodynamics monitoring can effectively identify infants at high risk for PMV following VSD repair. This approach may provide a valuable tool for perioperative management and resource allocation.