Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case鈥揷ontrol study

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• 作者：Bettina Ruf (1)
  Vittorio Bonelli (2)
  Gunter Balling (1)
  J眉rgen H枚rer (3)
  Nicole Nagdyman (1)
  Siegmund Lorenz Braun (4)
  Peter Ewert (1)
  Karl Reiter (5)
  
  1. Department of Pediatric Cardiology and Congenital Heart Disease ; German Heart Centre Munich ; Technical University ; Lazarettstr. 36 ; 80636 ; Munich ; Germany
  2. Department of Anaesthesiology ; German Heart Centre Munich ; Technical University ; Lazarettstr. 36 ; 80636 ; Munich ; Germany
  3. Department of Thoracic and Cardiovascular Surgery ; German Heart Centre Munich ; Technical University ; Lazarettstr. 36 ; 80636 ; Munich ; Germany
  4. Institute of Laboratory Medicine ; German Heart Centre Munich ; Technical University ; Lazarettstr. 36 ; 80636 ; Munich ; Germany
  5. Department of Pediatric Intensive Care ; University Children`s Hospital ; von Haunersche Children hospital ; Ludwigs-Maximilian University ; Lindwurmstr. 4 ; 80337 ; Munich ; Germany
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,982 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evaluate the relationship between renal oximetry and development of AKI in the operative and post-operative setting in infants undergoing cardiopulmonary bypass surgery. Methods In this prospective study, we enrolled 59 infants undergoing cardiopulmonary bypass surgery for congenital heart disease for univentricular (n鈥?鈥?6) or biventricular (n鈥?鈥?3) repair. Renal NIRS was continuously measured intraoperatively and for at least 24聽hours postoperatively and analysed for the intraoperative and first 12聽hours, first 24聽hours and first 48聽hours postoperatively. The renal oximetry values were correlated with the paediatric risk, injury, failure, loss, end (pRIFLE) classification for AKI, renal biomarkers and the postoperative course. Results Twenty-eight (48%) infants developed AKI based on pRIFLE classification. Already during intraoperative renal oximetry and further in the first 12聽hours, 24聽hours and 48聽hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P鈥?鈥?.05). Of the 28 patients who developed AKI, 3 (11%) needed renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths occurred. Infants with decreased renal oximetry values developed significantly higher lactate levels 24聽hours after surgery. Cystatin C was a late parameter of AKI, and neutrophil gelatinase-associated lipocalin values were not correlated with AKI occurrence. Conclusion Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers. Renal NIRS might be a promising non-invasive tool of multimodal monitoring of kidney function and developing AKI in infants undergoing cardiac surgery with cardiopulmonary bypass.