Marco Piastra1, Alessandro Pizza2, Federica Tosi1,3, Sonia Mensi1,3, Luca Massimi4, Andrea De Bellis5, Daniele G Biasucci1, Ersilia Luca1, Giorgio Conti1, Daniele De Luca1,6. 1. Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy. 2. Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy. a.pizza87@gmail.com. 3. Pediatric NeuroAnesthesia, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy. 4. Pediatric Neurosurgery, Department of Neuroscience, University Hospital "A. Gemelli", Catholic Universit Medical School, Rome, Italy. 5. Plastic Surgery and Burn Unit, S. Eugenio Hospital, Rome, Italy. 6. APHP, South Paris University Hospitals, Medical Center "A.Beclere", Paris, France.
Abstract
BACKGROUND: Studies have suggested that both the degree and the duration of hyperglycemia are independent risk factors for adverse outcome both in pediatric anesthesia and in critically ill children. In a recent paper, we combined intraoperative glycemic variations and length of surgery creating a metabolic glucose-related stress index called "Glycemic Stress Index" (GSI). AIM: To validate GSI for predicting PICU stay in a population of children undergoing different major neurosurgical procedures. METHODS: A total of 352 patients with craniotomy were enrolled. Basic clinical data and PICU length of stay were recorded real time. Intraoperative blood loss has been determined considering the estimated red cell volume loss ratio. GSI was calculated and subjected to ROC analysis having as targets PICU length of stay >100 or >200 h. RESULTS: The overall mean PICU stay was 35 h. Correlation analysis confirmed a low but highly significant direct correlation between GSI and PICU length of stay. ROC analysis showed an area under the ROC curve (AUC) of 0.74 (p = 0.03) for GSI to predict PICU stay >200 h and an AUC of 0.67 (p = 0.01) to predict PICU stay >100 h. Best predictive cutoff values were 4.5 and 3.9, for PICU stay >200 and >100 h, respectively. Overall accuracy for the test is higher in predicting PICU stay >200 h. CONCLUSIONS: GSI significantly predicts prolonged PICU stay after major neurosurgery in a mixed population of children affected by different neurosurgical conditions.
BACKGROUND: Studies have suggested that both the degree and the duration of hyperglycemia are independent risk factors for adverse outcome both in pediatric anesthesia and in critically ill children. In a recent paper, we combined intraoperative glycemic variations and length of surgery creating a metabolic glucose-related stress index called "Glycemic Stress Index" (GSI). AIM: To validate GSI for predicting PICU stay in a population of children undergoing different major neurosurgical procedures. METHODS: A total of 352 patients with craniotomy were enrolled. Basic clinical data and PICU length of stay were recorded real time. Intraoperative blood loss has been determined considering the estimated red cell volume loss ratio. GSI was calculated and subjected to ROC analysis having as targets PICU length of stay >100 or >200 h. RESULTS: The overall mean PICU stay was 35 h. Correlation analysis confirmed a low but highly significant direct correlation between GSI and PICU length of stay. ROC analysis showed an area under the ROC curve (AUC) of 0.74 (p = 0.03) for GSI to predict PICU stay >200 h and an AUC of 0.67 (p = 0.01) to predict PICU stay >100 h. Best predictive cutoff values were 4.5 and 3.9, for PICU stay >200 and >100 h, respectively. Overall accuracy for the test is higher in predicting PICU stay >200 h. CONCLUSIONS: GSI significantly predicts prolonged PICU stay after major neurosurgery in a mixed population of children affected by different neurosurgical conditions.
Entities:
Keywords:
Hyperglycemia; Neurosurgery; Outcome; Pediatric intensive care unit; Pediatric intensive care unit stay; Postoperative care
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