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Comparison of Intraoperative Aminophylline Versus Furosemide in Treatment of Oliguria During Pediatric Cardiac
Ali Mirza Onder1, David Rosen, Charles Mullett
11Division of Pediatric Nephrology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV 2Division of Pediatric Cardiothoracic Anesthesiology, Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV. 3Department of Pediatrics, Division of Pediatric Intensive Care Unit, West Virginia University School of Medicine, Morgantown, WV. 4Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV. 5Division of Pediatric Cardiothoracic Surgery, Department of Surgery, West Virginia University School of Medicine, Morgantown, WV. 6Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV.
Insights
Intraoperative aminophylline improved early urine output and reduced the need for renal replacement therapy in children after heart surgery compared to furosemide. However, it did not significantly decrease acute kidney injury incidence.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Nephrology
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant concern in pediatric patients.
- Oliguria is a common complication following pediatric cardiac surgery.
- Furosemide is a standard treatment for oliguria, but its efficacy in preventing CSA-AKI is debated.
Purpose of the Study:
- To compare the efficacy of intraoperative aminophylline versus furosemide in preventing or attenuating postoperative CSA-AKI in children undergoing cardiac surgery.
- To evaluate the impact of these interventions on renal outcomes, including acute kidney injury (AKI) and renal replacement therapy (RRT).
Main Methods:
- Retrospective cohort study comparing children with congenital heart disease who received intraoperative furosemide or aminophylline for oliguria.
- Primary outcomes included AKI and RRT use at 48 hours postoperatively.
- Surgical complexity was adjusted using the Risk Adjustment for Congenital Heart Surgery-1 score.
Main Results:
- Aminophylline group showed significantly higher urine output in the first 8 hours postoperatively (5.1 vs 3.4 mL/kg/hr; p=0.01).
- No significant difference in AKI incidence at 48 hours (38% vs 47%; p=0.29).
- Fewer aminophylline patients required RRT (1 vs 7; p=0.03), and aminophylline was a negative predictor for RRT.
Conclusions:
- Intraoperative aminophylline effectively reversed early postoperative oliguria compared to furosemide.
- Aminophylline use was associated with a lower incidence of RRT-requiring AKI in pediatric cardiac surgery patients.
- Further prospective studies are warranted to confirm the role of intraoperative aminophylline in preventing CSA-AKI.
Objectives:
To determine if intraoperative aminophylline was superior to furosemide to prevent or attenuate postoperative cardiac surgery-associated acute kidney injury.
Design:
Single-center, historical control, retrospective cohort study.
Setting:
PICU, university-affiliated children's hospital.
Patients:
Children with congenital heart disease in PICU who received furosemide or aminophylline to treat intraoperative oliguria.
Interventions:
Intraoperative oliguria was treated either with furosemide (September 2007 to February 2012) or with aminophylline (February 2012 to June 2013). The postoperative 48 hours renal outcomes of the aminophylline group were compared with the furosemide group. The primary outcomes were acute kidney injury and renal replacement therapy use at 48 hours postoperatively. Surgical complexity was accounted for by the use of Risk Adjustment for Congenital Heart Surgery-1 score.
Measurements And Main Results:
The study involves 69 months of observation. There were 200 cases younger than 21 years old reviewed for this study. Eighty-five cases (42.5%) developed acute kidney injury. The aminophylline group patients produced significantly more urine (mL/kg/hr) during the first 8 hours postoperatively than furosemide patients (5.1 vs 3.4 mL/kg/hr; p = 0.01). The urine output at 48 hours postoperatively was similar between the two groups. There was no difference in acute kidney injury incidence at 48 hours between the aminophylline and furosemide groups (38% vs 47%, respectively; p = 0.29). Fewer aminophylline group subjects required renal replacement therapy compared to the furosemide group subjects (n = 1 vs 7, respectively; p = 0.03). In the multi-variant predictive model, intraoperative aminophylline infusion was noted as a negative predictive factor for renal replacement therapy, but not for cardiac surgery-associated acute kidney injury.
Conclusion:
The intraoperative use of aminophylline was more effective than furosemide in reversal of oliguria in the early postoperative period. There were less renal replacement therapy-requiring acute kidney injury in children in the aminophylline group. Future prospective studies of intraoperative aminophylline to prevent cardiac surgery-associated acute kidney injury may be warranted.
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