Prediction of imminent, severe deterioration of children with parallel circulations using real-time processing of physiologic data

Craig G. Rusin, Sebastian I. Acosta, Lara S. Shekerdemian, Eric L. Vu, Aarti C. Bavare, Risa B. Myers, Lance W. Patterson, Ken M. Brady, Daniel J. Penny
2016 Journal of Thoracic and Cardiovascular Surgery  
Objectives-Sudden death is common in patients with hypoplastic left heart syndrome and comparable lesions with parallel systemic and pulmonary circulation from a common ventricular chamber. It is hypothesized that unforeseen acute deterioration is preceded by subtle changes in physiologic dynamics prior to overt clinical extremis. Our objective is to develop a computer algorithm to automatically recognize precursors to deterioration in real-time, providing an early warning to care staff.
more » ... -Continuous high-resolution physiologic recordings were obtained from 25 children with parallel systemic and pulmonary circulation who were admitted to the CVICU of Texas Children's Hospital between their early neonatal palliation and stage 2 surgical palliation. Instances of cardiorespiratory deterioration (defined as the need for CPR or endotracheal intubation) were found via a chart review. A classification algorithm was applied to both primary and derived parameters that were significantly associated with deterioration. The algorithm was optimized to discriminate pre-deterioration physiology from stable physiology. Results-Twenty cardiorespiratory deterioration events were identified in 13 of the 25 infants. The resulting algorithm was both sensitive and specific for detecting impending events, one to two hours in advance of overt extremis (ROC Area = 0.91, 95% CI = 0.88-0.94).
doi:10.1016/j.jtcvs.2016.03.083 pmid:27174513 pmcid:PMC4921264 fatcat:vv4annpjfvh7pbilbi2hpxshbe