Goal-directed perfusion to reduce acute kidney injury after pediatric cardiac surgery.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-10-30 DOI:10.1016/j.athoracsur.2024.10.015

Feng Long, Yan Zhang, Ming Luo, Ting Liu, Zhen Qin, Bo Wang, Yiheng Zhou, Ronghua Zhou

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引用次数: 0

Abstract

Background: Although the goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) has been discussed a lot in adult studies, no pediatric indexed oxygen delivery (DO₂i) thresholds are universally accepted, and no pediatric randomized controlled trial (RCT) is reported until now. This study aimed to determine whether the GDP initiative (maintaining DO₂i ≥ 360 mL/min/m² during CPB) could reduce the incidence of acute kidney injury (AKI) after pediatric cardiac surgery and improve clinical outcomes.

Methods: This single-center RCT enrolled 312 pediatric patients, who were randomized to receive either the GDP strategy or a conventional perfusion strategy during CPB. The primary outcome was the rate of postoperative AKI. Secondary outcomes included major postoperative complications, all-cause mortality within 30 days and short-term clinical outcomes after surgery.

Results: AKI occured in 43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the control group (relative risk, 0.67; 95% confidence interval, 0.49-0.91; P = 0.010). In the subgroup analysis, The GDP group had a lower AKI rate compared with the control group among patients with age less than 1 year, with nadir temperature greater than 32°C and nadir hemoglobin less than 8 g/L during CPB, with preoperative cyanosis, and with CPB duration from 60 to 120 minutes.

Conclusions: The GDP strategy aimed at maintaining DO₂i ≥ 360 mL/min/m² during CPB is effective in reducing the risk of AKI after pediatric cardiac surgery.

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目标定向灌注，减少小儿心脏手术后的急性肾损伤。

背景：尽管心肺旁路（CPB）期间的目标定向灌注（GDP）在成人研究中已被讨论过很多次，但儿科的指数氧输送（DO2i）阈值尚未被普遍接受，到目前为止也没有儿科随机对照试验（RCT）的报道。本研究旨在确定GDP倡议（CPB期间维持DO2i≥360 mL/min/m2）是否能降低小儿心脏手术后急性肾损伤（AKI）的发生率并改善临床预后：这项单中心 RCT 纳入了 312 名儿科患者，他们被随机分配到 CPB 期间接受 GDP 策略或传统灌注策略。主要结果是术后 AKI 发生率。次要结果包括术后主要并发症、30 天内全因死亡率和术后短期临床结果：GDP 组有 43 名患者（28.1%）发生了 AKI，对照组有 65 名患者（42.2%）发生了 AKI（相对风险为 0.67；95% 置信区间为 0.49-0.91；P = 0.010）。在亚组分析中，与对照组相比，GDP 组患者中年龄小于 1 岁、CPB 期间最低体温高于 32°C、最低血红蛋白低于 8 g/L、术前发绀、CPB 持续时间为 60 至 120 分钟的患者的 AKI 发生率较低：在 CPB 期间维持 DO2i ≥ 360 mL/min/m2 的 GDP 策略可有效降低小儿心脏手术后发生 AKI 的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.