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Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

Ruf B, Bonelli V, Balling G, Hörer J, Nagdyman N, Braun SL, Ewert P, Reiter K - Crit Care (2015)

Bottom Line: Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05).Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery.Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. ruf@dhm.mhn.de.

ABSTRACT

Introduction: Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evaluate the relationship between renal oximetry and development of AKI in the operative and post-operative setting in infants undergoing cardiopulmonary bypass surgery.

Methods: In this prospective study, we enrolled 59 infants undergoing cardiopulmonary bypass surgery for congenital heart disease for univentricular (n = 26) or biventricular (n = 33) repair. Renal NIRS was continuously measured intraoperatively and for at least 24 hours postoperatively and analysed for the intraoperative and first 12 hours, first 24 hours and first 48 hours postoperatively. The renal oximetry values were correlated with the paediatric risk, injury, failure, loss, end (pRIFLE) classification for AKI, renal biomarkers and the postoperative course.

Results: Twenty-eight (48%) infants developed AKI based on pRIFLE classification. Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths occurred. Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery. Cystatin C was a late parameter of AKI, and neutrophil gelatinase-associated lipocalin values were not correlated with AKI occurrence.

Conclusion: Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers. Renal NIRS might be a promising non-invasive tool of multimodal monitoring of kidney function and developing AKI in infants undergoing cardiac surgery with cardiopulmonary bypass.

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Related in: MedlinePlus

Example of calculating the area under the curve with the baseline of >25 % decrease of the preoperative individual averaged value of renal near-infrared spectroscopy. In this case, the area is calculated as 75% × 0.25 = 56%. NIRS, Near-infrared spectroscopy; rSO2, Regional oxygenation.
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Fig2: Example of calculating the area under the curve with the baseline of >25 % decrease of the preoperative individual averaged value of renal near-infrared spectroscopy. In this case, the area is calculated as 75% × 0.25 = 56%. NIRS, Near-infrared spectroscopy; rSO2, Regional oxygenation.

Mentions: After recording the renal oximetry values intra- and postoperatively, a renal rSO2 score was calculated. This score has been established in studies on cerebral NIRS after cardiac surgery in adult patients, but up to now not in infants [17]. It represents an area under the curve (AUC) measurement that reflects both the depth and duration of desaturations below the set thresholds (Figures 1 and 2). We adapted the score for long-term measurements by using minutes instead of seconds in the numerator, which gives the formula: rSO2 score = (baseline rSO2 − current rSO2 (%)) × time (minutes). In this article, the following abbreviation for the two renal NIRS thresholds are used: rNIRS65 = renal rSO2 < 65% and rNIRS25 = renal rSO2 decrease of 25% compared with a preoperative baseline value.Figure 1


Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

Ruf B, Bonelli V, Balling G, Hörer J, Nagdyman N, Braun SL, Ewert P, Reiter K - Crit Care (2015)

Example of calculating the area under the curve with the baseline of >25 % decrease of the preoperative individual averaged value of renal near-infrared spectroscopy. In this case, the area is calculated as 75% × 0.25 = 56%. NIRS, Near-infrared spectroscopy; rSO2, Regional oxygenation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4336470&req=5

Fig2: Example of calculating the area under the curve with the baseline of >25 % decrease of the preoperative individual averaged value of renal near-infrared spectroscopy. In this case, the area is calculated as 75% × 0.25 = 56%. NIRS, Near-infrared spectroscopy; rSO2, Regional oxygenation.
Mentions: After recording the renal oximetry values intra- and postoperatively, a renal rSO2 score was calculated. This score has been established in studies on cerebral NIRS after cardiac surgery in adult patients, but up to now not in infants [17]. It represents an area under the curve (AUC) measurement that reflects both the depth and duration of desaturations below the set thresholds (Figures 1 and 2). We adapted the score for long-term measurements by using minutes instead of seconds in the numerator, which gives the formula: rSO2 score = (baseline rSO2 − current rSO2 (%)) × time (minutes). In this article, the following abbreviation for the two renal NIRS thresholds are used: rNIRS65 = renal rSO2 < 65% and rNIRS25 = renal rSO2 decrease of 25% compared with a preoperative baseline value.Figure 1

Bottom Line: Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05).Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery.Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. ruf@dhm.mhn.de.

ABSTRACT

Introduction: Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evaluate the relationship between renal oximetry and development of AKI in the operative and post-operative setting in infants undergoing cardiopulmonary bypass surgery.

Methods: In this prospective study, we enrolled 59 infants undergoing cardiopulmonary bypass surgery for congenital heart disease for univentricular (n = 26) or biventricular (n = 33) repair. Renal NIRS was continuously measured intraoperatively and for at least 24 hours postoperatively and analysed for the intraoperative and first 12 hours, first 24 hours and first 48 hours postoperatively. The renal oximetry values were correlated with the paediatric risk, injury, failure, loss, end (pRIFLE) classification for AKI, renal biomarkers and the postoperative course.

Results: Twenty-eight (48%) infants developed AKI based on pRIFLE classification. Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths occurred. Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery. Cystatin C was a late parameter of AKI, and neutrophil gelatinase-associated lipocalin values were not correlated with AKI occurrence.

Conclusion: Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers. Renal NIRS might be a promising non-invasive tool of multimodal monitoring of kidney function and developing AKI in infants undergoing cardiac surgery with cardiopulmonary bypass.

Show MeSH
Related in: MedlinePlus