Goal-directed perfusion to reduce acute kidney injury after pediatric cardiac surgery.

Abstract

Background: Although the goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) has been discussed a lot in adult studies, no pediatric indexed oxygen delivery (DO₂i) thresholds are universally accepted, and no pediatric randomized controlled trial (RCT) is reported until now. This study aimed to determine whether the GDP initiative (maintaining DO₂i ≥ 360 mL/min/m² during CPB) could reduce the incidence of acute kidney injury (AKI) after pediatric cardiac surgery and improve clinical outcomes.

Methods: This single-center RCT enrolled 312 pediatric patients, who were randomized to receive either the GDP strategy or a conventional perfusion strategy during CPB. The primary outcome was the rate of postoperative AKI. Secondary outcomes included major postoperative complications, all-cause mortality within 30 days and short-term clinical outcomes after surgery.

Results: AKI occured in 43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the control group (relative risk, 0.67; 95% confidence interval, 0.49-0.91; P = 0.010). In the subgroup analysis, The GDP group had a lower AKI rate compared with the control group among patients with age less than 1 year, with nadir temperature greater than 32°C and nadir hemoglobin less than 8 g/L during CPB, with preoperative cyanosis, and with CPB duration from 60 to 120 minutes.

Conclusions: The GDP strategy aimed at maintaining DO₂i ≥ 360 mL/min/m² during CPB is effective in reducing the risk of AKI after pediatric cardiac surgery.