Congenital: Mechanical Circulatory SupportOxygen delivery in pediatric cardiac surgery and its association with acute kidney injury using machine learning
Graphical abstract
Section snippets
Study Design and Patient Selection
This was a retrospective analysis of patients aged younger than 18 years (maximum age treated at the institution), who underwent cardiac surgery with CPB for congenital heart disease at Great Ormond Street Hospital, London. The cohort was selected using a National Institute for Cardiovascular Outcomes Research (NICOR) validated data set for patients operated on between April 2019 and April 2021. Patients with preexisting kidney failure (defined as a serum creatinine level >1.5 times the normal
Demographic Characteristics and Operative Data
A total of 396 patients were included in the analysis (Figure 1). Postoperative AKI within 48 hours occurred in 102 (25.8%) patients (75 [18.9%] met urine output criteria first, whereas 27 [6.9%] met creatinine criteria first). All 102 patients exhibited reduced urine output, whereas 97 (95%) exhibited serum creatinine changes. Those who developed AKI were younger than those who did not (4 [IQR, 2-11] vs 7 [IQR, 3-27] months; P = .025; Table 2). Both groups displayed similar proportions of
Discussion
Delivery of adequate oxygenation is fundamental to CPB. Imbalances between oxygen supply and demand lead to cellular injury causing profound adenosine triphosphate depletion and nitric oxide generation, which in turn induces a number of oxidative and apoptotic mechanisms.3 However, data determining the critical level of oxygen to prevent a supply–demand mismatch, and thereby mitigate AKI, are lacking in pediatric practice. Because of the higher basal metabolic rate in children, it is reasonable
Conclusions
The present data support previous findings that global oxygen delivery during CPB is an independent risk factor for AKI development, supporting the concept of goal directed perfusion for improving patient outcomes. Further work is required to determine if a strategy of maintaining Do2i >350 mL/min/m2 can aid in reducing the incidence of pediatric AKI after CPB. Awareness of Do2i alongside the reduction of other known independent risk factors for AKI, such as prolonged CPB duration, will likely
References (30)
- et al.
Anaerobic metabolism during cardiopulmonary bypass: predictive value of carbon dioxide derived parameters
Ann Thorac Surg
(2006) - et al.
Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations
Ann Thorac Surg
(2005) - et al.
Time-dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury
J Thorac Cardiovasc Surg
(2019) - et al.
Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery
Br J Anaesth
(2019) - et al.
Nadir oxygen delivery on bypass and hypotension increase acute kidney injury risk after cardiac operations
Ann Thorac Surg
(2015) - et al.
Nadir oxygen delivery during pediatric bypass as a predictor of acute kidney injury
Ann Thorac Surg
(2022) - et al.
Predictive capacity of oxygen delivery during cardiopulmonary bypass on acute kidney injury
Ann Thorac Surg
(2019) - et al.
Novel urinary biomarkers for acute kidney injury and prediction of clinical outcomes after pediatric cardiac surgery
Pediatr Cardiol
(2020) - et al.
Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study
Crit Care Med
(2011) Cardiopulmonary bypass and AKI: AKI is bad, so let’s get beyond the diagnosis
Front Pediatr
(2019)
Is it time for goal-directed therapy in perfusion
J Extra Corpor Technol
O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
Crit Care
Duration of critically low oxygen delivery is associated with acute kidney injury after cardiac surgery
Acta Anaesthesiol Scand
Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population
Intensive Care Med
The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study
Perfusion
Cited by (6)
Nadir oxygen delivery during cardiopulmonary bypass in acute type A aortic dissection repair
2023, Journal of Thoracic DiseaseIndexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury
2023, Journal of Extra-Corporeal Technology