Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury,Pediatric Nephrology

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Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury
Pediatric Nephrology ( IF 3 ) Pub Date : 2021-08-26 , DOI: 10.1007/s00467-021-05234-1
Jennifer E Fishbein ₁ , Matthew Barone ₂ , James B Schneider ₃ , David B Meyer ₄ , John Hagen ₅ , Adnan Bakar ₃ , Kalliopi Grammatikopoulos ₂ , Christine B Sethna _{2,

6}

Affiliation

Background

Blood pressure variability (BPV), defined as the degree of variation between discrete blood pressure readings, is associated with poor outcomes in acute care settings. Acute kidney injury (AKI) is a common and serious postoperative complication of cardiac surgery with cardiopulmonary bypass (CPB) in children. No studies have yet assessed the association between intraoperative BPV during cardiac surgery with CPB and the development of AKI in children.

Methods

A retrospective chart review of children undergoing cardiac surgery with CPB was performed. Intraoperative BPV was calculated using average real variability (ARV) and standard deviation (SD). Multiple regression models were used to examine the association between BPV and outcomes of AKI, hospital and intensive care unit (PICU) length of stay, and length of mechanical ventilation.

Results

Among 231 patients (58% males, median age 8.6 months) reviewed, 51.5% developed AKI (47.9% Stage I, 41.2% Stage II, 10.9% Stage III). In adjusted models, systolic and diastolic ARV were associated with development of any stage AKI (OR 1.40, 95% CI 1.08–1.8 and OR 1.4, 95% CI 1.05–1.8, respectively). Greater diastolic SD was associated with longer PICU length of stay (β 0.94, 95% CI 0.62–1.2). When stratified by age, greater systolic ARV and SD were associated with AKI in infants ≤ 12 months, but there was no relationship in children > 12 months.

Conclusions

Greater BPV during cardiac surgery with CPB was associated with development of postoperative AKI in infants, suggesting that BPV is a potentially modifiable risk factor for AKI in this high-risk population.

Graphical abstract

中文翻译：

小儿心脏手术期间的血压变异性与急性肾损伤有关

背景

血压变异性 (BPV) 定义为离散血压读数之间的变异程度，与急性护理环境中的不良结果相关。急性肾损伤（AKI）是儿童体外循环（CPB）心脏手术常见且严重的术后并发症。尚无研究评估心脏手术期间 CPB 术中 BPV 与儿童 AKI 发展之间的关联。

方法

对接受 CPB 心脏手术的儿童进行了回顾性图表审查。使用平均实际变异性 (ARV) 和标准差 (SD) 计算术中 BPV。多元回归模型用于检查 BPV 与 AKI 结局、医院和重症监护室 (PICU) 住院时间以及机械通气时间之间的关联。

结果

在回顾的 231 名患者（58% 男性，中位年龄 8.6 个月）中，51.5% 发生 AKI（47.9% 第一期，41.2% 第二期，10.9% 第三期）。在调整后的模型中，收缩压和舒张压 ARV 与任何阶段 AKI 的发展相关（分别为 OR 1.40、95% CI 1.08-1.8 和 OR 1.4、95% CI 1.05-1.8）。更大的舒张期 SD 与更长的 PICU 住院时间相关（β 0.94, 95% CI 0.62–1.2）。当按年龄分层时，更大的收缩压 ARV 和 SD 与 ≤ 12 个月婴儿的 AKI 相关，但在大于 12 个月的儿童中没有相关性。