Lara Hessels1, Tim G Coulson2, Siven Seevanayagam3, Paul Young4, David Pilcher5, Nada Marhoon6, Rinaldo Bellomo7. 1. Data Analytics, Research and Evaluation (DARE) Centre, Austin Hospital, University of Melbourne, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 2. Department of Anaesthesia, Austin Hospital, Melbourne, Australia. 3. Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia. 4. Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand. 5. Department of Intensive Care, Alfred Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 6. Data Analytics, Research and Evaluation (DARE) Centre, Austin Hospital, University of Melbourne, Melbourne, Australia. 7. Data Analytics, Research and Evaluation (DARE) Centre, Austin Hospital, University of Melbourne, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Centre of Integrated Critical Care, University of Melbourne, Melbourne, Australia; School of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: Rinaldo.bellomo@austin.org.au.
Abstract
OBJECTIVE: To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. DESIGN: Retrospective analysis. SETTING: Tertiary intensive care unit. PARTICIPANTS: Cardiac surgery patients. INTERVENTIONS: Observational study. MEASUREMENTS AND MAIN RESULTS: The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. CONCLUSIONS: The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
OBJECTIVE: To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. DESIGN: Retrospective analysis. SETTING: Tertiary intensive care unit. PARTICIPANTS: Cardiac surgery patients. INTERVENTIONS: Observational study. MEASUREMENTS AND MAIN RESULTS: The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. CONCLUSIONS: The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
Authors: Vasileios Zochios; Joht Singh Chandan; Marcus J Schultz; Andrew Conway Morris; Ken Kuljit Parhar; Marc Giménez-Milà; Caroline Gerrard; Alain Vuylsteke; Andrew A Klein Journal: J Cardiothorac Vasc Anesth Date: 2019-11-08 Impact factor: 2.628
Authors: Tim G Coulson; Michael Bailey; Chris Reid; Gil Shardey; Jenni Williams-Spence; Sue Huckson; Shaila Chavan; David Pilcher Journal: BMC Med Inform Decis Mak Date: 2021-02-02 Impact factor: 2.796
Authors: Ashwin Sankar; Alexandra J Rotstein; Bijan Teja; François Martin Carrier; Emilie P Belley-Côté; Daniel Bolliger; Tarit Saha; Paula Carmona; Michael Sander; Nadine Shehata; Kevin E Thorpe; C David Mazer Journal: Can J Anaesth Date: 2022-09-19 Impact factor: 6.713