Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Ann Thorac Surg. 2022 Feb;113(2):647-653. doi: 10.1016/j.athoracsur.2021.01.026. Epub 2021 Jan 29.
Cardiac surgery-associated acute kidney injury (CS-AKI) is common in infants and is associated with negative outcomes. Nadir indexed oxygen delivery (DOi) during cardiopulmonary bypass (CPB) is associated with the occurrence of postoperative CS-AKI, with critical thresholds for DOi reported to be 262 to 300 mL/min/m in adults. However, given that infants have a higher metabolic rate and oxygen demand, the critical DOi in infants is not comparable with existing adult standards. This study aimed to explore the critical DOi threshold during pediatric CPB.
Between March 2019 and April 2020, 106 consecutive infants undergoing cardiac surgery with CPB were admitted to this prospective observational cohort study. The DOi levels of each patient were monitored during CPB. Pre- and intraoperative factors were tested for independent association with CS-AKI. The postoperative outcomes of patients with or without CS-AKI were compared.
In our patient population (n = 83), we identified 25 patients (38.5%) with postoperative CS-AKI. Multivariate analysis revealed 2 independent risk factors for onset of CS-AKI: CPB duration and nadir DOi. The lowest suitable DOi during CPB in the present population was 353 mL/min/m (sensitivity, 65.6%; specificity, 74.5%). CS-AKI during pediatric CPB remained significantly associated with an increased morbidity, related mainly to a postoperative low cardiac output syndrome, but not to mortality.
The lowest suitable DOi during CPB in the infant population undergoing cardiac surgery was 353 mL/min/m. Below this threshold, there was a high probability of inducing CS-AKI.
心脏手术相关急性肾损伤（CS-AKI）在婴儿中很常见，并且与不良结局相关。体外循环（CPB）期间的最低氧输送指数（DOi）与术后 CS-AKI 的发生相关，已有报道称成人 DOi 的临界阈值为 262 至 300 mL/min/m。然而，由于婴儿的代谢率和氧气需求较高，婴儿的临界 DOi 与现有的成人标准不可比。本研究旨在探讨小儿 CPB 期间的临界 DOi 阈值。
2019 年 3 月至 2020 年 4 月，连续纳入 106 例行心脏手术并接受 CPB 的婴儿进行前瞻性观察队列研究。在 CPB 期间监测每位患者的 DOi 水平。测试术前和术中因素与 CS-AKI 的独立关联。比较 CS-AKI 患者与无 CS-AKI 患者的术后结局。
在我们的患者人群（n=83）中，我们确定了 25 名（38.5%）术后发生 CS-AKI 的患者。多变量分析显示，CS-AKI 发生的 2 个独立危险因素为 CPB 持续时间和 DOi 最低值。在本研究人群中，CPB 期间最低适宜 DOi 为 353 mL/min/m（灵敏度，65.6%；特异性，74.5%）。小儿 CPB 期间的 CS-AKI 仍然与发病率增加显著相关，主要与术后低心输出量综合征有关，但与死亡率无关。
行心脏手术的婴儿 CPB 期间的最低适宜 DOi 为 353 mL/min/m。低于此阈值，诱导 CS-AKI 的可能性很高。
