Clinical Study Of Perioperative Renal Protection In Children With Tetralogy Of Fallot

Objective:Acute Kidney Injury(AKI)is a common occurrence in children undergone corrective surgery for Tetralogy of Fallot(TOF).We,therefore,collected clinical data to risk factors related to AKI.Methods:A total of 731 children,already undergone corrective procedures for TOF aged less than 3-years during the period starting from March 1st 2010 to March 1st 2013,were reviewed.Children with AKI were picked using Acute Kidney Injury Network criteria.Demographic and perioperative variables of the remaining cases were reviewed.Univariate analyses was performed to compare AKI with non-AKI group.Multivariable analyses was carried out to identify significant determinants of AKI.Results:A total of 240 children were found had developed AKI.univariate analysis showed:Age,Nakata index,McGoon index,LVEDV,Transannular RVOT patch,FFP in prime solution had significant differences.Multivariable logistic regression showed that in older children(OR1.425,95%CI:1.071-1.983,P=.011)with more transfusion of fresh frozen plasma(FFP)in the priming solution(OR:1.486;95%CI:1.325-2.674;P<.001)leads to higher morbidity of mild AKI.In addition,there is an increase in morbidity related to AKI when children had had less Nakata index(OR:0.282,95%CI:0.092-0.869,P=.013).Conclusion:Postoperative AKI increases in older children group.Infusion of more FFP in priming solution increases morbidity of AKI.The less Nakata index is significantly associated with severe AKI.Object:Children with Tetralogy of Fallot(TOF)usually have had severe cyanotic symptoms because of a delay to sought medical help here in China.These children with TOF often suffer from severe hemodynamics instability and tissue hypoperfusion.It may have adverse effects on kidney funciton.Therefore,We collected clinical data to investigate the effects of severe cyanosis related to acute kidney injury(AKI).Methods:A total of 271 children,already undergone corrective procedures for TOF aged less than 3-years during the period starting from March 1st 2010 to March 1st 2013,were collected.Children with severe cyanosis were picked using criteria hemoglobin>180g/L.Demographic and perioperative variables of the cases were reviewed.Univariate analyses was performed to compare severe cyanosis with non-severe cyanosis group.Multivariable analyses was carried out to identify significant determinants of AKI.Results:A total of 48 children were found to have developed severe cyanosis.In univariate analysis,there are higher incidence of postoperative complications,longer mechanical ventilation time and time to negative fluid balance;the mobidity of AKI has no statstic difference between severe cyanosis group and non-severe cyanosis group.Multivariable logistic regression showed that.The children in SC have higher incidence of complications(OR:14.322,95%CI:7.114-26.251,P<.001)and longer time to negative fluid balance(OR:4.823,95%CI:2.586-8.941,P=.002).The severe cyanosis can significantly increases mechanical ventilation time(OR:3.432,95%CI:1.014-5.978,P= 015)Conclusion:Except postoperative AKI,the severe cyanosis increase the morbidity of complications,prolongs mechanical ventilation time and increased the time to negative fluid balance.The severe cyanosis may predicate poor outcomes.Objective:Fluid overload is common in children after pediatric cardiac operation,especially they have obstructive lesions of the right heart,and is associated with poor outcomes.Peritoneal dialysis(PD)improves outcomes in children with postoperative fluid overload,but the criteria for evaluating high risk of fluid overload in children with restrictive right ventricular lesions are limited.This prospective cohort study was conducted to investigate if early PD is associated with improved outcomes in children with restrictive right ventricular lesions at high risk forfluid overload.Methods:Using empirical risk evaluation,159 children with restrictive right ventricular lesions at risk of fluid overload were included in this study.Fifty-three children were early initiated PD within 6 hours of admission in pediatric ICU(earl PD group),who had been doubly age-matched to children undergoing similar procedures without early initiation of PD(control group).Results:Demographic and baseline data was almost similar in all patients The early PD group showed a higher rate of negative fluid balance at 24 hours(35.85%vs.60.38%,P=.003);shorter time to negative fluid balance(median:42.70 hours,IQR:25.09-68.13 hours,vs.median:22.32 hours,IQR:13.50-39.52 hours,P<.001);lower VIS at 24 hours(median:21,IQR:17-23 vs.median:17,IQR:16-21,P=.008);and shorter mechanical ventilation time(median:75.82 hours,IQR:63.11-139.50 hours vs.median:54.03 hours,IQR:31.50-97.52 hours,P<.001).Conclusions:Compared to the control group,the early PD group showed a lower time to attain negative fluid balance,less inotropic requirement and shorter mechanical ventilation time.Based on empirical risk-evaluation practice,early PD improves postoperative recovery in children with restrictive right ventricular lesions.