High levels of free haemoglobin in neonates and infants undergoing surgery on cardiopulmonary bypass

Ricci, Zaccaria; Pezzella, Chiara; Romagnoli, Stefano; Iodice, Francesca; Haiberger, Roberta; Carotti, Adriano; Cogo, Paola

doi:10.1093/icvts/ivu129

Cited by 26 publications

(22 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Consistent with prior studies, ΔPHb was associated with CPB duration [3, 8, 19], likely from the mechanical destruction of red cells. Release of PHb disrupts the biological effects of nitric oxide (NO) and contributes to oxidative injury [12, 20–22].…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Kim‐Campbell

Gretchen

Callaway

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

Objective To determine the relationship between the production of cell-free plasma hemoglobin (PHb) and acute kidney injury (AKI) in infants and children undergoing cardiopulmonary bypass (CPB) for cardiac surgery. Design Prospective observational study Setting 12-bed cardiac ICU in a university-affiliated children’s hospital Patients Children were prospectively enrolled during their pre-operative outpatient appointment with the following criteria: >1month to <18 years old, procedures requiring CPB, no preexisting renal dysfunction. Interventions None Measurements and Main Results Plasma and urine were collected at baseline (in a subset), the beginning and end of CPB, and 2h and 24h after CPB in 60 subjects. Levels of PHb increased during CPB and were associated (p<0.01) with CPB duration (R2=0.22), depletion of Hp at end and 24h after CPB (R2=0.12 and 0.15, respectively), LDH levels at end CPB (R2=0.27), and change in creatinine (R2=0.12). 43% of patients developed AKI. There was an association between PHb level and change in creatinine that varied by age (overall [R2=0.12, p<0.01], in age >2yrs [R2=0.22, p<0.01], and in <2yrs [R2=0.03, p=0.42]). Change in PHb and male gender were found to be risk factors for AKI (OR 1.02 and OR 3.78, p<0.05). Conclusions Generation of PHb during CPB and male gender are associated with subsequent renal dysfunction in low risk pediatric patients, especially in those >2yrs of age. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing CPB would benefit from potential treatments for hemolysis and PHb-associated renal dysfunction.

show abstract

Section: Discussionsupporting

confidence: 89%

“…Possible contributors include hypoperfusion or ischemia-reperfusion induced inflammation. Age, particularly neonates, and CPB duration are associated with increased risk of AKI [3, 8, 9]. Because AKI can occur without measurable hypoperfusion, its association with longer CPB durations suggest that CPB can directly injure the kidney.…”

Section: Introductionmentioning

confidence: 99%

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Kim‐Campbell

Gretchen

Callaway

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Nitric oxide scavenging also promotes systemic inflammation and a prothrombotic state . Glomerular Hb filtration may cause renal injury due to both iron‐facilitated generation of reactive oxygen species and tubular obstruction . Cardiac surgical patients in particular suffer haptoglobin depletion, making them particularly sensitive to the deleterious effects of free Hb …”

Section: Discussionmentioning

confidence: 99%

Expediting red blood cell transfusions by syringing causes significant hemolysis

2017

View full text Add to dashboard Cite

show abstract

“…The potential mechanisms of haemoglobin‐mediated AKI include intratubular haemoglobin precipitation causing obstruction, iron‐facilitated oxidant damage to tubular epithelial cells and induction of vasoconstriction due to reduced nitric oxide bioavailability . CPB‐related haemolysis is caused by mechanical shear stress within the extracorporeal circuit including roller pumps, turbulent passage through the oxygenator, reservoir, filters, arterial and venous cannulae, cardiotomy suction, the air‐to‐blood interface, cell salvage and transfusion . There is also an increase in RBC fragility and aggregability due to contact with the foreign extracorporeal circuit…”

Section: Risk Factors For Cardiac Surgery‐associated Acute Kidney Injurymentioning

confidence: 99%

“…48 CPB-related haemolysis is caused by mechanical shear stress within the extracorporeal circuit including roller pumps, turbulent passage through the oxygenator, reservoir, filters, arterial and venous cannulae, cardiotomy suction, the air-to-blood interface, cell salvage and transfusion. 49 There is also an increase in RBC fragility and aggregability due to contact with the foreign extracorporeal circuit. 50 Vermuelen Windsant et al found that haemolysis indicated by free haemoglobin plasma levels and nitric oxide consumption significantly increased in cardiac surgery patients undergoing CPB (P < 0.0001).…”

Section: Haemolysis Acute Kidney Injury and Cardiopulmonary Bypassmentioning

confidence: 99%

Mending a broken heart but breaking the kidney

2016

View full text Add to dashboard Cite

This review describes the risk factors related to cardiopulmonary bypass that contribute to the development of AKI, in particular the role of remote ischaemic preconditioning on the effect of pre-existing CKD. ABSTRACT:The incidence of acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery. In 2013, 95% of cardiac surgical procedures performed in Australia and New Zealand used cardiopulmonary bypass (CPB). AKI following CPB is well known, yet the perioperative factors contributing to its development are incompletely understood. AKI following CPB has significant implications on both short-term and long-term outcomes. The techniques for conducting CPB have evolved, moving towards evidence-based practice; however, there is still no generally accepted definition of optimal perfusion and its conduct. This review examines the current incidence of AKI following cardiac surgery and the short-term and longer-term effects of AKI on morbidity and mortality. The purpose of this review is to discuss the perioperative risk factors related to CPB and their contribution to the development of AKI. This review will also discuss outcomes in regard to off-pump cardiac surgery, the role of remote ischaemic preconditioning on AKI and outcomes in patients with chronic renal failure undergoing cardiac surgery.

show abstract

High levels of free haemoglobin in neonates and infants undergoing surgery on cardiopulmonary bypass

Abstract: A high rate of fHb is released during paediatric surgery with CPB in infants. fHb mainly depends on the left atrial venting flow rate and CPB duration. However, such peaks of fHb levels were not associated with renal dysfunction.

Cited by 26 publications

References 14 publications

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Expediting red blood cell transfusions by syringing causes significant hemolysis

Mending a broken heart but breaking the kidney

Contact Info

Product

Resources

About