Goal-directed Perfusion to Reduce Acute Kidney Injury After Pediatric Cardiac Operation.

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

Methods: This single-center randomized controlled trial 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 operation.

Results: AKI occurred in 43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the control group (relative risk, 0.67; 95% CI, 0.49-0.91; P = .010). In the subgroup analysis, the GDP group had a lower AKI rate compared with the control group among patients aged less than 1 year, with a nadir temperature greater than 32 °C and a nadir hemoglobin value 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 Doi ≥360 mL/min/m during CPB is effective in reducing the risk of AKI after pediatric cardiac operation.