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Goal-directed Perfusion to Reduce Acute Kidney Injury After Pediatric Cardiac Operation

Feng Long1, Yan Zhang1, Ming Luo1

  • 1Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.

The Annals of Thoracic Surgery
|November 1, 2024
PubMed

Insights

Goal-directed perfusion (GDP) significantly reduced acute kidney injury (AKI) after pediatric cardiac surgery. This strategy maintains indexed oxygen delivery (Do2i) during cardiopulmonary bypass (CPB).

Area of Science:

  • Pediatric Cardiac Surgery
  • Cardiopulmonary Bypass
  • Nephrology

Background:

  • Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) is under-researched in pediatrics.
  • No universally accepted pediatric indexed oxygen delivery (Do2i) thresholds exist.
  • Pediatric randomized controlled trials on GDP are lacking.

Purpose of the Study:

  • To evaluate the effectiveness of a GDP strategy in reducing acute kidney injury (AKI) post-pediatric cardiac operation.
  • To determine if maintaining Do2i ≥360 mL/min/m2 during CPB improves clinical outcomes.
  • To assess the impact of GDP on major postoperative complications and mortality.

Main Methods:

  • Single-center randomized controlled trial involving 312 pediatric patients.
  • Patients were randomized to either a GDP strategy or a conventional perfusion strategy during CPB.
  • Primary outcome was the incidence of postoperative AKI; secondary outcomes included complications and mortality.

Main Results:

  • The GDP group showed a significantly lower AKI rate (28.1%) compared to the control group (42.2%), with a relative risk of 0.67 (P = .010).
  • Subgroup analyses indicated reduced AKI in infants, patients with specific temperature and hemoglobin nadirs, preoperative cyanosis, and CPB duration of 60-120 minutes.
  • No significant difference in major postoperative complications or 30-day mortality was reported (data not shown in abstract).

Conclusions:

  • The GDP strategy, targeting Do2i ≥360 mL/min/m2 during CPB, effectively reduces AKI risk in pediatric cardiac surgery patients.
  • This approach offers a promising method for improving perioperative kidney protection in pediatric cardiac operations.
  • Further research may explore optimal Do2i thresholds and long-term outcomes.
Abstract

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