Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure.

Staehler, Helena; Ono, Masamichi; Schober, Patrick; Kido, Takashi; Heinisch, Paul Philipp; Strbad, Martina; Vodiskar, Janez; Cleuziou, Julie; Lemmer, Julia; Balling, Gunter; Hager, Alfred; Ewert, Peter; Hörer, Jürgen

doi:10.1093/ejcts/ezac014

journal article

Title:: Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure.
Document type:: Journal Article
Author(s):: Staehler, Helena; Ono, Masamichi; Schober, Patrick; Kido, Takashi; Heinisch, Paul Philipp; Strbad, Martina; Vodiskar, Janez; Cleuziou, Julie; Lemmer, Julia; Balling, Gunter; Hager, Alfred; Ewert, Peter; Hörer, Jürgen
Abstract:: OBJECTIVES: This study was performed to determine the clinical and haemodynamic variables associated with early adverse outcomes after the neonatal Norwood procedure. METHODS: Patients who underwent the neonatal Norwood procedure between 2001 and 2019 were included. The patient diagnosis, morphological characteristics and haemodynamic parameters were analysed to identify factors associated with length of stay (LOS) in the intensive care unit (ICU) and mortality during the stay. RESULTS: A total of 322 patients were depicted. The median age and weight at the Norwood procedure were 9 days and 3.2 kg, respectively. Certain morphological and preoperative parameters, such as birth weight below 2.5 kg, restrictive atrial septal defect, extracardiac anomalies and the diameter of the ascending aorta, were found to be associated with the LOS in the ICU. Analysis using early postoperative haemodynamic variables revealed that systolic arterial pressure, diastolic arterial pressure, serum lactate levels and reduced ventricular function at 2 days postoperatively were associated with the LOS in the ICU. Birth weight <2.5 kg (P = 0.010), a restrictive atrial septal defect (P = 0.001) and smaller ascending aorta (P = 0.039) were associated with death in the ICU. Reduced ventricular function, lower systolic aortic pressure and higher lactate levels at various time points (P < 0.05) were also associated with ICU deaths. The LOS in the ICU was significantly associated with late mortality (P < 0.001, Hazard Ratio (HR) = 1.015). CONCLUSIONS: The LOS in the ICU after the Norwood procedure was predicted by early postoperative haemodynamic variables, suggesting that good early postoperative haemodynamics determine early recovery. A prolonged stay in the ICU after the Norwood procedure was associated with late mortality.
Journal title abbreviation:: Eur J Cardiothorac Surg
Year:: 2022
Journal volume:: 61
Journal issue:: 6
Pages contribution:: 1271-1280
Fulltext / DOI:: doi:10.1093/ejcts/ezac014
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/35089334
Print-ISSN:: 1010-7940
TUM Institution:: Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (Prof. Hörer); Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Ewert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (DHM) (Prof. Hörer)2022

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2022