Document Detail


Point of care testing: improving pediatric outcomes.
MedLine Citation:
PMID:  15183294     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Goal-directed therapy (GDT) has been proven to reduce morbidly and mortality in critical illness. Point of care testing (POCT) allows rapid turn around time (TAT) of critical data, yet data suggesting improved outcomes are very limited. The impact of these two strategies on improving outcomes for patients after congenital heart surgery has never been evaluated. DESIGN: Beginning July 2001, POCT in the form of the i-STAT handheld analyzer was incorporated in the management of patients after congenital heart surgery at our institution. Blood lactate measurements were performed serially for 24 h after surgery. Based on a lactate value, medical therapy was escalated, diminished or left unchanged after surgery. Outcome data were collected prospectively for later review. Mortality at 30 days after surgery was compared for patients undergoing a GDT protocol to a group of historical cohorts. The operative risk for all operations was determined using the RACHS-1 scoring system. SETTING: A 16-bed Cardiac Intensive Care Unit (CICU) in a 268-bed free-standing pediatric hospital. PATIENTS: Outcomes of infants and neonates operated on from July 2001 through July 2003 (Group B) were compared to historical controls in our institution from June 1995 through June 2001 (Group A). There were 851 patients in Group A and 378 patients in Group B. Patients in Group B were smaller and younger than those in group A (median weight 3.8 vs. 4.3 kg, P < 0.001; median age 42 vs. 76 days, P = 0.02). MEASUREMENTS AND RESULTS: Overall mortality was lower for Group B as compared to Group A (2.4% vs. 6.2%, P < 0.007). Significant reduction in mortality between Group B and Group A was noted in neonates (4.3% vs. 12%, P = 0.008) but did not reach significance in infants (0.9% vs. 2.6%, P = NS). Patients undergoing the highest-risk operations (RACHS-1 groups 5 + 6) had a 70% reduction in mortality when comparing Group B to Group A, (9% vs. 30%, P = 0.03), but no statistical difference in mortality was noted in those patients undergoing lower-risk operations (RACHS-1 groups 1 and 2, Group B 0.5% vs. Group A 1.5%, P = NS). CONCLUSIONS: The combination of goal-directed therapy and point of care testing significantly reduced mortality in patients undergoing congenital heart surgery. This improvement is greatest in the youngest patients and those undergoing higher-risk surgeries.
Authors:
Anthony F Rossi; Danyal Khan
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical biochemistry     Volume:  37     ISSN:  0009-9120     ISO Abbreviation:  Clin. Biochem.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-08     Completed Date:  2004-12-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0133660     Medline TA:  Clin Biochem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  456-61     Citation Subset:  IM    
Affiliation:
Cardiac Intensive Care Program, Miami Children's Hospital, Miami, FL 33155, USA. anthony.rossi@mch.com
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MeSH Terms
Descriptor/Qualifier:
Blood Gas Analysis / instrumentation*,  methods
Carbon Dioxide / blood
Florida
Heart Defects, Congenital / surgery,  therapy*
Hospital Mortality
Hospitals, Pediatric
Humans
Hydrogen-Ion Concentration
Infant
Infant, Newborn
Intensive Care Units, Neonatal
Lactic Acid / blood*
Oxygen / blood
Postoperative Period
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 50-21-5/Lactic Acid; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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