title: Clinical Factors Associated with Dose of Loop Diuretics After Pediatric Cardiac Surgery: Post Hoc Analysis.
abstract: A post hoc analysis of a randomized controlled trial comparing the clinical effects of furosemide and ethacrynic acid was conducted. Infants undergoing cardiac surgery with cardiopulmonary bypass were included in order to explore which clinical factors are associated with diuretic dose in infants with congenital heart disease. Overall, 67 patients with median (interquartile range) age of 48 (13-139) days were enrolled. Median diuretic dose was 0.34 (0.25-0.4) mg/kg/h at the end of postoperative day (POD) 0 and it significantly decreased (p = 0.04) over the following PODs; during this period, the ratio between urine output and diuretic dose increased significantly (p = 0.04). Age (r -0.26, p = 0.02), weight (r -0.28, p = 0.01), cross-clamp time (r 0.27, p = 0.03), administration of ethacrynic acid (OR 0.01, p = 0.03), and, at the end of POD0, creatinine levels (r 0.3, p = 0.009), renal near-infrared spectroscopy saturation (-0.44, p = 0.008), whole-blood neutrophil gelatinase-associated lipocalin levels (r 0.30, p = 0.01), pH (r -0.26, p = 0.02), urinary volume (r -0.2755, p = 0.03), and fluid balance (r 0.2577, p = 0.0266) showed a significant association with diuretic dose. At multivariable logistic regression cross-clamp time (OR 1.007, p = 0.04), use of ethacrynic acid (OR 0.2, p = 0.01) and blood pH at the end of POD0 (OR 0.0001, p = 0.03) was independently associated with diuretic dose. Early resistance to loop diuretics continuous infusion is evident in post-cardiac surgery infants: Higher doses are administered to patients with lower urinary output. Independently associated variables with diuretic dose in our population appeared to be cross-clamping time, the administration of ethacrynic acid, and blood pH.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Haiberger
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Favia
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy.|Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cogo
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. z.ricci@libero.it.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
mesh_terms: D006348:Cardiac Surgical Procedures; D004232:Diuretics; D005665:Furosemide; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000071068:Lipocalin-2; D049994:Sodium Potassium Chloride Symporter Inhibitors
chemical_list: D004232:Diuretics; D000071068:Lipocalin-2; D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide
keywords: Acute kidney injury; Cardiopulmonary bypass; Fluid balance; Loop diuretics; Metabolic alkalosis; Pediatric cardiac surgery