HIGH-DOSE FENOLDOPAM REDUCES POST OPERATIVE NGAL AND CYSTATIN C LEVELS DURING PEDIATRIC CARDIAC SURGERY
Italy 
1 slide(s) – English – 2010-10-23
Objective: Fenoldopam mesilate, a selective DA-1 receptor agonist causes systemic vasodilatation and increased renal blood flow and tubular sodium excretion. Our study aimed to evaluate the effects of high dose fenoldopam infusion on renal function during cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD). Neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C (CYS C) have recently emerged as sensitive and specific biomarkers of renal function.
Design: A prospective randomized double-blind controlled trial was performed (Clinical Trial.Gov Id: NCT00982527).
Setting: Pediatric cardiac surgery intensive care unit.
Patients and methods:
INCLUSION CRITERIA:
Age under 1 year
Need for cardiac surgery and CPB for correction of CHD with biventricular anatomy
RACHS > 1
EXCLUSION CRITERIA:
CPB requiring deep hypothermic cardiac arrest
Palliation for univentricular anatomy
Simple ventricular septal defect and atrial septal defect
Pre-operative renal disfunction
DATA COLLECTION
Data were collected before surgery (t0), at the end of surgical procedure (t1) and 12 hours after intensive care unit admission (t2)
Primary outcome:
SAFETY OF FENODOPAM HIGH DOSE
Decreased urinary levels of NGAL
Decreased urinary levels of CYS C
2) Secondary outcomes:
CPB and intraoperative urinary output, hemofiltation volume during CPB
Postoperative serum creatinine level and urinary output
use of diuretic and vasodilatators drugs during and after CPB, systemic vascular resistances (SVR), oxygen delivery (DO2)
ICU stay, days of mechanical ventilation, need for RRT/PD, survival
Results:
A total of 72 patients were enrolled in this study from March 2009 to July 2010: 36 received fenoldopam at the dose of 1 mcg/kg/min during CPB and 36 received placebo.
No differences were present in baseline data between the two groups.
High-dose fenoldopam infusion during CPB is safe: no interruption of fenoldopam infusion during CPB in the two groups due to unexpected side effects or excessive hypotension, no differences in post-op IS.
A statistically significant decrease in urinary levels of NGAL and CYS-C in fenoldopam group was shown.
None of the secondary outcomes was statistically significant between the two groups except length of ICU stay and ventilation days.
A significant reduction in furosemide/VASODILATORS administration was present in the fenoldopam group.
Conclusions:
High-dose fenoldopam during CPB in pediatric patients undergoing cardiac surgery for CHD with biventricular anatomy did not cause hypotension during CPB nor an increase in post-operative inotropic score, it significantly decreased serum and urinary levels of NGAL and CYS-C, it allowed an optimization of diuretics and vasodilatators administration during CPB.
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