Introduction
Materials and methods
Study design
Objectives
Study population
Randomization procedure
Interventions
Data collection
Statistical analysis
Results
Group F | Group P |
P
| |
---|---|---|---|
Age (days) | 145 (156) | 139 (130) | 0.791 |
Weight (kg) | 5.1 (2.0) | 5.0 (2.2) | 0.652 |
BSA (m2) | 0.5 (0.2) | 0.5 (0.3) | 0.698 |
RACHS II score | 2.7 (0.6) | 2.6 (0.6) | 0.366 |
Surgical procedure (minutes) | 390 (84) | 401 (82) | 0.599 |
CPB (minutes) | 212 (70) | 217 (74) | 0.905 |
Crossclamp (minutes) | 119 (44) | 118 (41) | 0.923 |
Prescribed CPB flow (ml/kg/min) | 150 (0) | 150 (0) | 0.90 |
Ht during CPB (%) | 32 (1.9) | 33 (2.1) | 0.237 |
T min during CPB (°) | 27.1 (2.5) | 27.8 (1.9) | 0.418 |
Diagnoses | Group F | Group P |
---|---|---|
Number of neonates/total number of patients | 13/40 | 13/40 |
PA + VSD | 2 | 1 |
PA + VDS + MAPCAS | 2 | 2 |
CAVc | 5 | 5 |
Aortic coarctation and VSD | 2 | 2 |
ASD-VSD | 2 | 2 |
Ao supravalvar stenosis | 2 | 2 |
TOF | 12 | 14 |
TGA and VSD | 2 | 1 |
IS-TGA | 9 | 9 |
TA | 2 | 2 |
Total | 40 | 40 |
Primary end points
T0 | T1 | T2 |
P
| ||||
---|---|---|---|---|---|---|---|
Group F | Group P | Group F | Group P | Group F | Group P | ||
uNGAL (ng/ml) | 37.2 (84.5) | 37 (232) | 94.2 (240)a | 140 (249) | 20.4 (15.7)a | 57 (105) | 0.025 |
pNGAL (ng/ml) | 62 (33) | 66 (31) | 88 (38) | 96 (40) | 93 (45) | 99 (41) | 0.253 |
uCys C (mg/l) | 0.12 (0.2) | 0.08 (0.06) | 0.16 (0.3)a | 0.22 (0.5) | 0.06 (0.04) | 0.09 (0.13) | 0.039 |
pCys C (mg/l) | 1.0 (0.3) | 1.1 (0.3) | 0.96 (0.28) | 1.0 (0.25) | 1.19 (0.3) | 1.3 (0.3) | 0.344 |
pCrea (mg/dl) | 0.51 (0.15) | 0.46 (0.16) | 0.63 (0.17) | 0.64 (0.13) | 0.64 (0.2) | 0.62 (0.2) | 0.114 |
uCrea (mg/dl) | 53.5 (37.4) | 49.6 (33.7) | 8.5 (5.5) | 8.5 (7.6) | 26.4 (23.4) | 26.4 (23.7) | 0.707 |
Secondary end points
T0 | T1 | T2 |
P
| ||||
---|---|---|---|---|---|---|---|
Group F | Group P | Group F | Group P | Group F | Group P | ||
MAP (mm Hg) | 53.1 (8.6) | 54.6 (10.7) | 62.9 (10.9) | 64.6 (14.0) | 65.7 (13.0) | 62.5 (11.2) | 0.99 |
IS | 0 (0) | 0 (0) | 9.5 (5) | 12.7 (9) | 8.7 (5) | 9.1 (6) | 0.374 |
Lactates (mM) | 1.0 (0.5) | 0.9 (0.5) | 3.3 (2.4) | 3.8 (2.5) | 1.6 (1.0) | 1.9 (1.5) | 0.433 |
ScvO2 (%) | 59.6 (16.6) | 59.8 (17.3) | 58.1 (15.0) | 59.0 (15.3) | 61.9 (16.0) | 56.7 (14.8) | 0.555 |
rSO2c (%) | 58.0 (12.1) | 58.6 (10.9) | 59.8 (15.3) | 56.9 (14.7) | 64.0 (9.3) | 63.5 (11.3) | 0.590 |
Diuresis (ml/kg/h) | 5.9 (5.2) | 6.9 (6.3) | 7.5 (6.7) | 6.8 (4.7) | 5.0 (2.5) | 4.7 (2.8) | 0.340 |
CPB phase | |||||||
Group F | Group P | ||||||
CPB pressa (mm Hg) | 47.2 (4.7) | 49.0 (4.6) | 0.048 | ||||
Effective CPB flowa (ml/kg/min) | 151 (12.5) | 146.5 (16) | 0.142 | ||||
IDO2a (ml O2/min/m2) | 342.4 (50.1) | 331.7 (58.7) | 0.460 | ||||
ISVRa (dyn·s·cm-5/m2) | 404.9 (59.8) | 423.5 (97.2) | 0.502 |
Discussion
Conclusions
Key messages
-
Cardiopulmonary bypass during pediatric cardiac surgery induces a significant increase of urinary and plasmatic NGAL and CysC levels from baseline to ICU admission followed by restoration of normal values after 12 hours.
-
Urinary NGAL and CysC increase is significantly reduced at the end of surgery and 12 hours after ICU admission by the infusion of 1 μg/kg/min of fenoldopam.
-
Fenoldopam infusion may improve systemic vasodilation and renal perfusion during CPB: compared with controls, a significant reduction in furosemide and phentolamine requirement during CPB was observed in patients receiving fenoldopam.
-
AKI incidence, as indicated by pRIFLE classification after pediatric cardiac surgery, is high. According to our data, it was 50% in patients receiving fenoldopam and 72% in controls.