Kenneth E Mah1,2, Shiying Hao2,3, Scott M Sutherland2,4, David M Kwiatkowski1,2, David M Axelrod1,2, Christopher S Almond1,2, Catherine D Krawczeski1,2, Andrew Y Shin5,6,7,8. 1. Division of Pediatric Cardiology, Department of Pediatrics, Stanford Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, CA, USA. 2. Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA, 94304, USA. 3. Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. 4. Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. 5. Division of Pediatric Cardiology, Department of Pediatrics, Stanford Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, CA, USA. drewshin@stanford.edu. 6. Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA, 94304, USA. drewshin@stanford.edu. 7. Center for Quality and Clinical Effectiveness, Stanford Children's Health, Stanford University Medical Center, Palo Alto, CA, USA. drewshin@stanford.edu. 8. Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, 750 Welch Road, Ste 305, Palo Alto, CA, 94304, USA. drewshin@stanford.edu.
Abstract
BACKGROUND: Fluid overload (FO) is common after neonatal congenital heart surgery and may contribute to mortality and morbidity. It is unclear if the effects of FO are independent of acute kidney injury (AKI). METHODS: This was a retrospective cohort study which examined neonates (age < 30 days) who underwent cardiopulmonary bypass in a university-affiliated children's hospital between 20 October 2010 and 31 December 2012. Demographic information, risk adjustment for congenital heart surgery score, surgery type, cardiopulmonary bypass time, cross-clamp time, and vasoactive inotrope score were recorded. FO [(fluid in-out)/pre-operative weight] and AKI defined by Kidney Disease Improving Global Outcomes serum creatinine criteria were calculated. Outcomes were all-cause, in-hospital mortality and median postoperative hospital and intensive care unit lengths of stay. RESULTS: Overall, 167 neonates underwent cardiac surgery using cardiopulmonary bypass in the study period, of whom 117 met the inclusion criteria. Of the 117 neonates included in the study, 76 (65%) patients developed significant FO (>10%), and 25 (21%) developed AKI ≥ Stage 2. When analyzed as FO cohorts (< 10%,10-20%, > 20% FO), patients with greater FO were more likely to have AKI (9.8 vs. 18.2 vs. 52.4%, respectively, with AKI ≥ stage 2; p = 0.013) and a higher vasoactive-inotrope score, and be premature. In the multivariable regression analyses of patients without AKI, FO was independently associated with hospital and intensive care unit lengths of stay [0.322 extra days (p = 0.029) and 0.468 extra days (p < 0.001), respectively, per 1% FO increase). In all patients, FO was also associated with mortality [odds ratio 1.058 (5.8% greater odds of mortality per 1% FO increase); 95% confidence interval 1.008,1.125;p = 0.032]. CONCLUSIONS: Fluid overload is an important independent contributor to outcomes in neonates following congenital heart surgery. Careful fluid management after cardiac surgery in neonates with and without AKI is warranted.
BACKGROUND: Fluid overload (FO) is common after neonatal congenital heart surgery and may contribute to mortality and morbidity. It is unclear if the effects of FO are independent of acute kidney injury (AKI). METHODS: This was a retrospective cohort study which examined neonates (age < 30 days) who underwent cardiopulmonary bypass in a university-affiliated children's hospital between 20 October 2010 and 31 December 2012. Demographic information, risk adjustment for congenital heart surgery score, surgery type, cardiopulmonary bypass time, cross-clamp time, and vasoactive inotrope score were recorded. FO [(fluid in-out)/pre-operative weight] and AKI defined by Kidney Disease Improving Global Outcomes serum creatinine criteria were calculated. Outcomes were all-cause, in-hospital mortality and median postoperative hospital and intensive care unit lengths of stay. RESULTS: Overall, 167 neonates underwent cardiac surgery using cardiopulmonary bypass in the study period, of whom 117 met the inclusion criteria. Of the 117 neonates included in the study, 76 (65%) patients developed significant FO (>10%), and 25 (21%) developed AKI ≥ Stage 2. When analyzed as FO cohorts (< 10%,10-20%, > 20% FO), patients with greater FO were more likely to have AKI (9.8 vs. 18.2 vs. 52.4%, respectively, with AKI ≥ stage 2; p = 0.013) and a higher vasoactive-inotrope score, and be premature. In the multivariable regression analyses of patients without AKI, FO was independently associated with hospital and intensive care unit lengths of stay [0.322 extra days (p = 0.029) and 0.468 extra days (p < 0.001), respectively, per 1% FO increase). In all patients, FO was also associated with mortality [odds ratio 1.058 (5.8% greater odds of mortality per 1% FO increase); 95% confidence interval 1.008,1.125;p = 0.032]. CONCLUSIONS: Fluid overload is an important independent contributor to outcomes in neonates following congenital heart surgery. Careful fluid management after cardiac surgery in neonates with and without AKI is warranted.
Entities:
Keywords:
Acute kidney injury; Cardiopulmonary bypass; Congenital heart defects; Critical care outcomes; Fluid balance; Postoperative care
Authors: M C Seghaye; R G Grabitz; J Duchateau; S Busse; S Däbritz; D Koch; G Alzen; H Hörnchen; B J Messmer; G Von Bernuth Journal: J Thorac Cardiovasc Surg Date: 1996-09 Impact factor: 5.209
Authors: Peter A McCullough; Josee Bouchard; Sushrut S Waikar; Edward D Siew; Zoltan H Endre; Stuart L Goldstein; Jay L Koyner; Etienne Macedo; Kent Doi; Salvatore Di Somma; Andrew Lewington; Ravi Thadhani; Raj Chakravarthi; Can Ice; Mark D Okusa; Jacques Duranteau; Peter Doran; Li Yang; Bertrand L Jaber; Shane Meehan; John A Kellum; Michael Haase; Patrick T Murray; Dinna Cruz; Alan Maisel; Sean M Bagshaw; Lakhmir S Chawla; Ravindra L Mehta; Andrew D Shaw; Claudio Ronco Journal: Contrib Nephrol Date: 2013-05-13 Impact factor: 1.580
Authors: Andrea Lassnigg; Daniel Schmidlin; Mohamed Mouhieddine; Lucas M Bachmann; Wilfred Druml; Peter Bauer; Michael Hiesmayr Journal: J Am Soc Nephrol Date: 2004-06 Impact factor: 10.121
Authors: Michael G Gaies; James G Gurney; Alberta H Yen; Michelle L Napoli; Robert J Gajarski; Richard G Ohye; John R Charpie; Jennifer C Hirsch Journal: Pediatr Crit Care Med Date: 2010-03 Impact factor: 3.624
Authors: Stephanie L Siehr; Shenghui Shi; Shiying Hao; Zhongkai Hu; Bo Jin; Frank Hanley; Vadiyala Mohan Reddy; Doff B McElhinney; Xuefeng Bruce Ling; Andrew Y Shin Journal: Pediatr Crit Care Med Date: 2016-03 Impact factor: 3.624
Authors: Katja M Gist; David T Selewski; John Brinton; Shina Menon; Stuart L Goldstein; Rajit K Basu Journal: Pediatr Crit Care Med Date: 2020-02 Impact factor: 3.624
Authors: Kevin A Pettit; David T Selewski; David J Askenazi; Rajit K Basu; Brian C Bridges; David S Cooper; Geoffrey M Fleming; Jason Gien; Stephen M Gorga; Jennifer G Jetton; Eileen C King; Heidi J Steflik; Matthew L Paden; Rashmi D Sahay; Michael Zappitelli; Katja M Gist Journal: Pediatr Nephrol Date: 2022-08-09 Impact factor: 3.651
Authors: Emily Schapka; Jerica Gee; John W Cyrus; Gregory Goldstein; Kara Greenfield; Mark Marinello; Oliver Karam Journal: J Pediatr Intensive Care Date: 2021-03-23
Authors: Tara M Neumayr; Jeffrey A Alten; David K Bailly; Priya N Bhat; Katie L Brandewie; J Wesley Diddle; Muhammad Ghbeis; Catherine D Krawczeski; Kenneth E Mah; Tia T Raymond; Garrett Reichle; Huaiyu Zang; David T Selewski Journal: Pediatr Nephrol Date: 2022-09-06 Impact factor: 3.651
Authors: David K Bailly; Jeffrey A Alten; Katja M Gist; Kenneth E Mah; David M Kwiatkowski; Kevin M Valentine; J Wesley Diddle; Sachin Tadphale; Shanelle Clarke; David T Selewski; Mousumi Banerjee; Garrett Reichle; Paul Lin; Michael Gaies; Joshua J Blinder Journal: Ann Thorac Surg Date: 2022-03-01 Impact factor: 5.102
Authors: Kenneth E Mah; Jeffrey A Alten; Timothy T Cornell; David T Selewski; David Askenazi; Julie C Fitzgerald; Alexis Topjian; Kent Page; Richard Holubkov; Beth S Slomine; James R Christensen; J Michael Dean; Frank W Moler Journal: Resuscitation Date: 2021-01-12 Impact factor: 5.262