Related Experiment Video
Updated: May 30, 2025
Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
Relationship between intraoperative blood pressure variability and postoperative acute kidney injury in pediatric
Rong Xiao1, Ming Luo2, Hong Yu2
1Department of Anesthesiology, Xichang People's Hospital, Xichang, 615000, Sichuan, China.
Insights
Increased blood pressure variability during pediatric cardiac surgery may increase the risk of acute kidney injury. This finding highlights a potential target for preventing kidney complications in children undergoing heart procedures.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Anesthesiology
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication in pediatric patients, with higher incidence than in adults.
- Limited evidence exists on the link between intraoperative blood pressure variability (BPV) and CSA-AKI in children undergoing cardiopulmonary bypass (CPB).
Purpose of the Study:
- To investigate the association between intraoperative blood pressure variability (BPV) and the development of cardiac surgery-associated acute kidney injury (CSA-AKI) in pediatric patients.
- To identify independent risk factors for CSA-AKI in this population.
Main Methods:
- Retrospective observational study of 570 children (0-7 years) undergoing cardiac surgery with CPB.
- Intraoperative BPV calculated using coefficients of variation (CVs) and area under the curve (AUC).
- Univariate and multivariate analyses performed to identify risk factors for CSA-AKI.
Main Results:
- 36.1% of patients developed CSA-AKI.
- Independent risk factors for CSA-AKI included male gender, RACHS-1 grade ≥3, longer CPB time, and higher peak intraoperative vasoactive-inotropic score (VIS).
- A trend towards significance was observed for MAP variations >30% AUC in univariate analysis, but not in multivariate analysis.
Conclusions:
- Greater blood pressure variability, particularly MAP variations exceeding 30% AUC during CPB, may be a potential risk factor for CSA-AKI in pediatric patients.
- Further large-scale clinical studies are needed to confirm the correlation between BPV and CSA-AKI.
Background:
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a notably common complication in pediatrics, with an incidence rate ranging from 15 to 64%. This rate is significantly higher than that observed in adults. Currently, there is a lack of substantial evidence regarding the association between intraoperative blood pressure variability (BPV) during cardiac surgery with cardiopulmonary bypass (CPB) and the development of AKI in pediatric patients.
Methods:
This retrospective observational study encompassed children aged 0-7 years undergoing cardiac surgery with CPB. Intraoperative BPV was calculated using coefficients of variation (CVs) and the area under the curve (AUC). Univariate and multivariate analyses were employed to identify risk factors associated with CSA-AKI.
Results:
Among 570 patients (median age 1 year) reviewed, 36.1% developed CSA-AKI (68.9% risk stage, 22.8% injury stage, and 8.3% failure stage). After adjusting for other variables, male gender (OR = 2.044, 95% CI 1.297-3.222, P = 0.002), congenital heart surgery risk assessment grade (RACHS-1) classification ≥ 3 (OR = 0.510, 95% CI 0.307-0.846, P = 0.009), longer CPB time (OR = 1.022, 95% CI 1.007-1.037, P = 0.004) and higher peak value of intraoperative vasoactive inotropic score (VIS) (OR = 1.072, 95% CI 1.026-1.119, P = 0.002) were identified as independent risk factors for CSA-AKI. ± 30% AUCm was different in univariate analysis (P = 0.014), however, not statistically different in multifactor analysis (P = 0.610).
Conclusion:
Greater BPV, specifically MAP variations exceeding 30% AUC during CPB, may be a potential risk factor for CSA-AKI in pediatric patients. Further large sample clinical studies are warranted to analyze the correlation between BPV and CSA-AKI.
Related Concept Videos
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:17Measurement of Blood Pressure