Gao Peng, Jin Yu, Zhang Peiyao, Wang Wenting, Hu Jinxiao, Liu Jinping
Pediatric Cardiac Surgery Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Dec 16;9:1020846. doi: 10.3389/fcvm.2022.1020846. eCollection 2022.
Acute kidney injury (AKI) is common after cardiac surgery with cardiopulmonary bypass (CPB) and is associated with increased mortality and morbidity. Nadir indexed oxygen delivery (DOi) lower than the critical threshold during CPB is a risk factor for postoperative AKI. The critical DOi for preventing AKI in children has not been well studied. The study aimed to explore the association between nadir DOi and postoperative AKI in infant cardiac surgery with CPB.
From August 2021 to July 2022, 413 low-weight infants (≤10 kg) undergoing cardiac surgery with CPB were consecutively enrolled in this prospective observational study. Nadir DOi was calculated during the hypothermia and rewarming phases of CPB, respectively. The association between nadir DOi and postoperative AKI was investigated in mild hypothermia (32-34°C) and moderate hypothermia (26-32°C).
A total of 142 (38.3%) patients developed postoperative AKI. In patients undergoing mild hypothermia during CPB, nadir DOi in hypothermia and rewarming phases was independently associated with postoperative AKI. The cutoff values of nadir DOi during hypothermia and rewarming phases were 258 mL/min/m and 281 mL/min/m, respectively. There was no significant association between nadir DOi and postoperative AKI in patients undergoing moderate hypothermia during CPB.
In low-weight infants undergoing mild hypothermia during CPB, the critical DOi for preventing AKI was 258 mL/min/m in the hypothermia phase and 281 mL/min/m for rewarming. Moreover, an individualized critical DOi threshold should be advocated during CPB.
急性肾损伤（AKI）在体外循环（CPB）心脏手术后很常见，且与死亡率和发病率增加相关。CPB期间最低指数氧输送（DOi）低于临界阈值是术后AKI的一个危险因素。儿童预防AKI的临界DOi尚未得到充分研究。本研究旨在探讨CPB婴儿心脏手术中最低DOi与术后AKI之间的关联。
2021年8月至2022年7月，413例体重≤10kg的低体重婴儿接受CPB心脏手术，连续纳入本前瞻性观察研究。分别在CPB的低温期和复温期计算最低DOi。在轻度低温（32 - 34°C）和中度低温（26 - 32°C）下研究最低DOi与术后AKI之间的关联。
共有142例（38.3%）患者发生术后AKI。在CPB期间接受轻度低温的患者中，低温期和复温期的最低DOi与术后AKI独立相关。低温期和复温期最低DOi的截断值分别为258 mL/min/m和281 mL/min/m。在CPB期间接受中度低温的患者中，最低DOi与术后AKI之间无显著关联。
在CPB期间接受轻度低温的低体重婴儿中，预防AKI的临界DOi在低温期为258 mL/min/m，复温期为281 mL/min/m。此外，在CPB期间应提倡个体化的临界DOi阈值。
