DataSheet1_A novel nomogram for predicting respiratory adverse events during transport after interventional cardiac catheterization in children.pdf

ObjectiveThe rate and predictors of respiratory adverse events (RAEs) during transport discharged from operating room after interventional cardiac catheterization in children remain unclear. This study aimed to investigate the incidence and predictors, and to construct a nomogram for predicting RAEs during transport in this pediatric surgical treatment.
MethodsThis prospective cohort study enrolled 290 consecutive pediatric patients who underwent ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) between February 2019 and December 2020. Independent predictors were used to develop a nomogram, and a bootstrap resampling approach was used to conduct internal validation. Composite RAEs were defined as the occurrence of at least 1 complication regarding laryngospasm, bronchospasm, apnea, severe cough, airway secretions, airway obstruction, and oxygen desaturation.
ResultsThe rate of RAEs during transport was 23.1% (67 out of 290). Multivariate analysis identified age (vs. ≤3 years, adjusted odds ratio (aOR) = 0.507, 95% confidence interval (CI), 0.268–0.958, P = 0.036), preoperative upper respiratory tract infections (URI, aOR = 2.335, 95% CI, 1.223–4.460, P = 0.01), type of surgery (vs. VSD, for ASD, aOR =  2.856, 95% CI, 1.272–6.411, P = 0.011; for PDA, aOR = 5.518, 95% CI, 2.425–12.553, P < 0.001), morphine equivalent (vs. ≤0.153 mg/kg, aOR = 2.904, 95% CI, 1.371–6.150, P = 0.005), atropine usage (aOR = 0.463, 95% CI, 0.244–0.879, P = 0.019), and RAEs during extubation to transport (aOR = 5.004, 95% CI, 2.633–9.511, P < 0.001) as independent predictors of RAEs during transport. These six candidate predictors were used to develop a nomogram, which showed a C-statistic value of 0.809 and good calibration (P = 0.844). Internal validation revealed similarly good discrimination (C-statistic, 0.782; 95% CI, 0.726–0.837) and calibration. Decision curve analysis (DCA) also demonstrated the clinical usefulness of the nomogram.
ConclusionThe high rate of RAEs during transport reminds us of the need for more medical care and attention. The proposed nomogram can reliably identify pediatric patients at high risk of RAEs during transport and guide clinicians to make proper transport plans. Our findings have important and meaningful implications for RAEs risk prediction, clinical intervention and healthcare quality control.

研究目的：儿童经介入性心导管术（interventional cardiac catheterization）后从手术室转运过程中发生呼吸不良事件（respiratory adverse events, RAEs）的发生率及其危险因素目前尚不明确。本研究旨在明确该类儿科介入治疗患者转运期间呼吸不良事件的发生率及危险因素，并构建用于预测该类事件的列线图（nomogram）。
研究方法：本研究为前瞻性队列研究，纳入2019年2月至2020年12月期间接受室间隔缺损（ventricular septal defects, VSD）、房间隔缺损（atrial septal defects, ASD）及动脉导管未闭（patent ductus arteriosus, PDA）修补术的连续入组儿科患者共290例。基于筛选出的独立危险因素构建列线图，并采用Bootstrap重抽样法进行内部验证。复合呼吸不良事件定义为至少发生以下1种并发症：喉痉挛、支气管痉挛、呼吸暂停、剧烈咳嗽、气道分泌物增多、气道梗阻及氧饱和度下降。
研究结果：转运期间呼吸不良事件总发生率为23.1%（290例患者中共67例发生）。多因素分析显示，年龄（以≤3岁为参照，校正比值比（adjusted odds ratio, aOR）=0.507，95%置信区间（confidence interval, CI）：0.268~0.958，P=0.036）、术前上呼吸道感染（upper respiratory tract infections, URI，aOR=2.335，95%CI：1.223~4.460，P=0.01）、手术类型（以VSD为参照，ASD患者aOR=2.856，95%CI：1.272~6.411，P=0.011；PDA患者aOR=5.518，95%CI：2.425~12.553，P<0.001）、吗啡等效剂量（以≤0.153mg/kg为参照，aOR=2.904，95%CI：1.371~6.150，P=0.005）、阿托品使用（aOR=0.463，95%CI：0.244~0.879，P=0.019）以及拔管后转运期间发生的呼吸不良事件（aOR=5.004，95%CI：2.633~9.511，P<0.001）为转运期间呼吸不良事件的独立危险因素。基于上述6项候选危险因素构建的列线图C统计量为0.809，校准度良好（P=0.844）。内部验证结果显示该模型同样具有良好的区分度（C统计量：0.782；95%CI：0.726~0.837）及校准度。决策曲线分析（Decision curve analysis, DCA）亦证实该列线图具有临床应用价值。
研究结论：转运期间呼吸不良事件的高发生率提示临床需加强此类患者的转运期医疗监护与关注。本研究构建的列线图可准确识别转运期间呼吸不良事件高风险的儿科患者，辅助临床医师制定合理的转运方案。本研究结果对呼吸不良事件的风险预测、临床干预及医疗质量控制均具有重要的指导意义。