Division of Pediatric Cardiac Anesthesia/Intensive Care Unit, Bambino Gesù Pediatric Hospital, Rome, Italy.
Pediatr Crit Care Med. 2012 Jan;13(1):e51-4. doi: 10.1097/PCC.0b013e3181fe4717.
To evaluate diagnostic and prognostic significance of neutrophil gelatinase-associated lipocalin during extracorporeal membrane oxygenation in children with congenital heart disease.
Prospective observational study.
Pediatric cardiac intensive care unit.
Ten pediatric patients with congenital heart disease requiring venoarterial extracorporeal membrane oxygenation for postoperative cardiorespiratory support were prospectively enrolled.
None.
Five patients were successfully weaned from extracorporeal membrane oxygenation and survived to intensive care unit discharge; five children died during extracorporeal therapy or within 12 hrs from extracorporeal membrane oxygenation stop. Continuous renal replacement therapy after extracorporeal membrane oxygenation start was indicated for three patients. When patients on continuous venovenous hemofiltration were compared with patients not on continuous venovenous hemofiltration, diuretic administration was lower (1.5 vs. 10 mg/kg/day), extracorporeal membrane oxygenation duration was longer (7 [range, 6-14]) vs. 4 [range, 3-8] days), and survival decreased from 60% (four of seven) to 33% (one of three). Neutrophil gelatinase-associated lipocalin levels were higher at the first extracorporeal membrane oxygenation day in patients who underwent continuous venovenous hemofiltration, 285 (range, 181-513) vs. 130 (range, 81-277) ng/mL, in patients who did not undergo continuous venovenous hemofiltration (p = .045). Neutrophil gelatinase-associated lipocalin levels remained higher among patients on continuous venovenous hemofiltration than others throughout the examined extracorporeal membrane oxygenation period (p = .0007), whereas creatinine levels tended to be equivalent between the two groups (p = .38). However, a trend toward increasing neutrophil gelatinase-associated lipocalin levels was noticed also in patients not on continuous venovenous hemofiltration.
Neutrophil gelatinase-associated lipocalin levels at the first extracorporeal membrane oxygenation day may have predictive value for continuous venovenous hemofiltration. During the course of extracorporeal membrane oxygenation support, creatinine levels were normalized in patients with acute kidney injury undergoing continuous venovenous hemofiltration; in these patients, neutrophil gelatinase-associated lipocalin levels may provide further information on kidney injury.
评估中性粒细胞明胶酶相关脂质运载蛋白在先天性心脏病儿童体外膜氧合期间的诊断和预后意义。
前瞻性观察性研究。
儿科心脏重症监护病房。
10 名接受静脉动脉体外膜氧合以支持术后心肺功能的先天性心脏病儿科患者前瞻性纳入研究。
无。
5 名患者成功脱离体外膜氧合并存活至重症监护病房出院；5 名患儿在体外治疗期间或体外膜氧合停止后 12 小时内死亡。3 名患者在体外膜氧合开始后需要连续肾脏替代治疗。与未行连续静脉-静脉血液滤过的患者相比，行连续静脉-静脉血液滤过的患者利尿剂用量较低（1.5 比 10mg/kg/天），体外膜氧合时间较长（7[范围，6-14]比 4[范围，3-8]天），存活率从 60%（7 人中的 4 人）降至 33%（3 人中的 1 人）。行连续静脉-静脉血液滤过的患者第 1 天的中性粒细胞明胶酶相关脂质运载蛋白水平较高，为 285（范围，181-513）ng/ml，而未行连续静脉-静脉血液滤过的患者为 130（范围，81-277）ng/ml（p=0.045）。在整个体外膜氧合期间，行连续静脉-静脉血液滤过的患者的中性粒细胞明胶酶相关脂质运载蛋白水平始终高于其他患者（p=0.0007），而两组的肌酐水平趋于相当（p=0.38）。然而，也注意到未行连续静脉-静脉血液滤过的患者的中性粒细胞明胶酶相关脂质运载蛋白水平呈升高趋势。
第 1 天体外膜氧合时的中性粒细胞明胶酶相关脂质运载蛋白水平可能对连续静脉-静脉血液滤过有预测价值。在体外膜氧合支持过程中，行连续静脉-静脉血液滤过的急性肾损伤患者的肌酐水平正常化；在这些患者中，中性粒细胞明胶酶相关脂质运载蛋白水平可能提供有关肾脏损伤的进一步信息。
