Document Detail


Fluid overload in infants following congenital heart surgery.
MedLine Citation:
PMID:  23249789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe postoperative fluid overload patterns and correlate degree of fluid overload with intensive care morbidity and mortality in infants undergoing congenital heart surgery.
DESIGN: Prospective, observational study. Fluid overload (%) was calculated by two methods: 1) (Total fluid in - Total fluid out)/(Preoperative weight) × 100; and 2) (Current weight - Preoperative weight)/(Preoperative weight) × 100. Composite poor outcome included: need for renal replacement therapy, upper quartile time to extubation or intensive care length of stay (> 6.5 and 9.9 days, respectively), or death ≤ 30 days after surgery.
SETTING: University hospital pediatric cardiac ICU.
PATIENTS: Forty-nine infants < 6 months of age undergoing congenital heart surgery with cardiopulmonary bypass during the period of July 2009 to July 2010.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Patients had a median age of 53 days (21 neonates) and mean weight of 4.5 ± 1.3 kg. Forty-two patients (86%) developed acute kidney injury by meeting at least Acute Kidney Injury Network and Kidney Disease Improving Global Outcomes stage 1 criteria (serum creatinine rise of 50% or ≥ 0.3mg/dL). The patients with adverse outcomes (n = 17, 35%) were younger (7 [5 - 10] vs. 98 [33 - 150] days, p = 0.001), had lower preoperative weight (3.7 ± 0.7 vs. 4.9 ± 1.4 kg, p = 0.0002), higher postoperative mean peak serum creatinine (SCr) (0.9 ± 0.3 vs. 0.6 ± 0.3mg/dL, p = 0.005), and higher mean maximum fluid overload by both method 1 (12% ± 10% vs. 6% ± 4%, p = 0.03) and method 2 (24% ± 15% vs. 14% ± 8%, p = 0.02). Predictors of a poor outcome from multivariate analyses were cardiopulmonary bypass time, use of circulatory arrest, and increased vasoactive medication requirements postoperatively.
CONCLUSIONS: Early postoperative fluid overload is associated with suboptimal outcomes in infants following cardiac surgery. Because the majority of patients developed kidney injury without needing renal replacement therapy, fluid overload may be an important risk factor for adverse outcomes with all degrees of acute kidney injury.
Authors:
Matthew A Hazle; Robert J Gajarski; Sunkyung Yu; Janet Donohue; Neal B Blatt
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  14     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-08     Completed Date:  2013-07-05     Revised Date:  2014-01-10    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  44-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / blood,  etiology,  therapy*
Age Factors
Body Fluids*
Body Weight*
Cardiopulmonary Bypass / adverse effects
Creatinine / blood
Fluid Therapy*
Heart Arrest, Induced / adverse effects
Heart Defects, Congenital / surgery
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Length of Stay
Multivariate Analysis
Postoperative Complications / etiology,  therapy*
Prospective Studies
Renal Replacement Therapy
Risk Factors
Time Factors
Treatment Outcome
Urine
Vasoconstrictor Agents / adverse effects
Vasodilator Agents / adverse effects
Grant Support
ID/Acronym/Agency:
K12 HD 028820/HD/NICHD NIH HHS; K12 HD028820/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 0/Vasodilator Agents; AYI8EX34EU/Creatinine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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