Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Hassinger, Amanda; Wald, Eric; Goodman, Denise M.

doi:10.1097/pcc.0000000000000043

Cited by 182 publications

(164 citation statements)

References 37 publications

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“…These two formal analyses are in accordance with the results of two prospective randomized controlled studies performed in children undergoing cardiac surgery, that reported the equivalence of tetrastarches compared to human albumin for perioperative fluid replacement, without any increase in the incidence of postoperative complications (Hanart, Khalife et al, 2009;Van der Linden, De Ville et al, 2013). In these studies, the tetrastarch was associated with a decreased fluid balance, which could have a significant impact on postoperative morbidity and mortality (Hassinger, Wald et al, 2014). These analyses also indicate that results observed in the critically ill population should not be extrapolated to other non-critically ill populations, such as the surgical patients.…”

Section: Levi Department Of Medicine Academic Medical Centre Unisupporting

confidence: 75%

Speaker Abstracts

2014

Transfusion Medicine

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Section: Levi Department Of Medicine Academic Medical Centre Unisupporting

confidence: 75%

Speaker Abstracts

2014

Transfusion Medicine

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“…37, 38 In patients with preoperative diastolic and renal dysfunction, fluid overload may develop during and after cardiac surgery where a significant amount of bleeding, transfusion and fluid shift occurs. Fluid overload may precede postoperative AKI, 39 and postoperative fluid overload is reported to be a predictor of clinical outcomes in both adult and pediatric cardiac surgery patients. 40 However, these associations were reported only in retrospective studies and a prospective study is required to determine whether fluid overload precedes AKI or is only Advance Publication by-J-STAGE association between a preoperative E/e′ >15 and AKI in the first 7 days following OPCAB in patients with preserved LV systolic function.…”

Section: Discussionmentioning

confidence: 99%

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

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“…Several other authors have reported that renal replacement therapy is delivered in up to 10% of children undergoing cardiac surgery for congenital heart disease, and is associated with a high mortality rate (17,18). In our study, 8.20% of the patients that had had cardiac surgery in the previous six years needed PD.…”

Section: Discussionmentioning

confidence: 62%

“…In our study, 8.20% of the patients that had had cardiac surgery in the previous six years needed PD. Although there is no evidence of renal dysfunction, a clinical condition of fluid retention and generalized edema is common in neonates after major cardiosurgical operations (18). Our postcardiac surgery patients needed PD mostly for oliguria/anuria.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis in Neonates: Six Years Single Centre Experince

Özlü¹,

Yapıcıoğlu²,

Seker³

et al. 2018

Turk J Med Sci

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Background/aim: Peritoneal dialysis (PD) is generally considered the practical dialysis modality for neonates in the treatment of acute kidney injury (AKI) and metabolic disturbances. The aim of this study was to evaluate the indications, complications, and outcomes of PD between January 2011 and December 2016. Materials and methods:This study included all 56 neonates that underwent PD over six years in our neonatal intensive care unit (NICU). A retrospective chart review was performed for all patients in our institution. Results:The incidence of PD was 1.32% (56/4230 patients) during this period. Mean birth weight of the patients was 2267.77 ± 1060.63 (540-5050) g. Thirty-four (60.7%) patients were premature. Fourteen patients (25%) were in the postoperative period of cardiac surgery due to congenital cardiac defects, fourteen patients (25%) were diagnosed with metabolic diseases, one patient had hypoxic ischemic encephalopathy, and another patient had severe pulmonary hypertension. Conclusion:In the acute setting of a neonatal intensive care unit, PD performed in a neonate provides a technically simple method of steady fluid, solute removal, and correction of electrolyte abnormalities. A trocar catheter appears safe even in premature babies, and closed three-way stopcock system seems to be reliable at the bedside in NICUs.

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Early Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients

Cited by 182 publications

References 37 publications

Speaker Abstracts

Speaker Abstracts

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Peritoneal Dialysis in Neonates: Six Years Single Centre Experince

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