Section of Cardiac Critical Care Medicine, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL.
Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
Pediatr Crit Care Med. 2018 Apr;19(4):310-317. doi: 10.1097/PCC.0000000000001478.
Cardiac surgery-induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery-induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery-induced acute kidney injury and other deleterious outcomes.
Retrospective chart review.
Pediatric cardiac ICU.
All infants younger than 90 days old admitted to the cardiac ICU from October 2012 to December 2015 who received at least one dose of furosemide in the first 24 hours after cardiopulmonary bypass surgery.
None.
Ninety-nine patients met inclusion and exclusion criteria. In total, 45.5% developed cardiac surgery-induced acute kidney injury. Median time between cardiopulmonary bypass and furosemide was 7.7 hours (interquartile range, 4.4-9.5). Six-hour cumulative urine output was 33% lower (p = 0.031) in patients with cardiac surgery-induced acute kidney injury. Area under the curve for prediction of cardiac surgery-induced acute kidney injury was 0.69 (p = 0.002). Other models demonstrated urine output response to furosemide had significant area under the curves for prediction of peak fluid over load greater than 15% (0.68; p = 0.047), prolonged peritoneal dialysis (area under the curve, 0.79; p = 0.007), prolonged mechanical ventilation (area under the curve, 0.79; p < 0.001), prolonged hospitalization (area under the curve, 0.62; p = 0.069) and mortality (area under the curve, 0.72; p = 0.05).
Urine output response to furosemide within 24 hours of cardiopulmonary bypass predicts cardiac surgery-induced acute kidney injury development and other important morbidity in children younger than 90 days old; prospective validation is warranted.
心脏手术后急性肾损伤在新生儿和婴儿中很常见，与术后发病率/死亡率相关；早期识别心脏手术后急性肾损伤对于减轻术后发病率可能至关重要。我们试图确定在体外循环后 24 小时内呋塞米后每小时或 6 小时累积尿量是否可以预测心脏手术后急性肾损伤的发生和其他不良结局。
回顾性图表审查。
儿科心脏重症监护病房。
2012 年 10 月至 2015 年 12 月期间，在体外循环手术后 24 小时内至少接受一次呋塞米治疗的所有 90 天以下的婴儿，入住心脏重症监护病房。
无。
99 例患者符合纳入和排除标准。共有 45.5%的患者发生心脏手术后急性肾损伤。体外循环与呋塞米之间的中位时间为 7.7 小时（四分位距，4.4-9.5）。发生心脏手术后急性肾损伤的患者 6 小时累积尿量低 33%（p=0.031）。预测心脏手术后急性肾损伤的曲线下面积为 0.69（p=0.002）。其他模型显示，呋塞米后尿量反应对预测超过 15%的峰值液体超负荷（0.68；p=0.047）、延长腹膜透析（曲线下面积，0.79；p=0.007）、延长机械通气（曲线下面积，0.79；p<0.001）、延长住院时间（曲线下面积，0.62；p=0.069）和死亡率（曲线下面积，0.72；p=0.05）具有显著的曲线下面积。
体外循环后 24 小时内呋塞米后尿量反应预测 90 天以下儿童心脏手术后急性肾损伤的发生和其他重要发病率；需要前瞻性验证。
