Comparison of Intraoperative Aminophylline Versus Furosemide in Treatment of Oliguria During Pediatric Cardiac Surgery

Abstract

Objectives: To determine if intraoperative aminophylline was superior to furosemide to prevent or attenuate postoperative cardiac surgery-associated acute kidney injury.

Design: Single-center, historical control, retrospective cohort study.

Setting: PICU, university-affiliated children's hospital.

Patients: Children with congenital heart disease in PICU who received furosemide or aminophylline to treat intraoperative oliguria.

Interventions: Intraoperative oliguria was treated either with furosemide (September 2007 to February 2012) or with aminophylline (February 2012 to June 2013). The postoperative 48 hours renal outcomes of the aminophylline group were compared with the furosemide group. The primary outcomes were acute kidney injury and renal replacement therapy use at 48 hours postoperatively. Surgical complexity was accounted for by the use of Risk Adjustment for Congenital Heart Surgery-1 score.

Measurements and main results: The study involves 69 months of observation. There were 200 cases younger than 21 years old reviewed for this study. Eighty-five cases (42.5%) developed acute kidney injury. The aminophylline group patients produced significantly more urine (mL/kg/hr) during the first 8 hours postoperatively than furosemide patients (5.1 vs 3.4 mL/kg/hr; p = 0.01). The urine output at 48 hours postoperatively was similar between the two groups. There was no difference in acute kidney injury incidence at 48 hours between the aminophylline and furosemide groups (38% vs 47%, respectively; p = 0.29). Fewer aminophylline group subjects required renal replacement therapy compared to the furosemide group subjects (n = 1 vs 7, respectively; p = 0.03). In the multi-variant predictive model, intraoperative aminophylline infusion was noted as a negative predictive factor for renal replacement therapy, but not for cardiac surgery-associated acute kidney injury.

Conclusion: The intraoperative use of aminophylline was more effective than furosemide in reversal of oliguria in the early postoperative period. There were less renal replacement therapy-requiring acute kidney injury in children in the aminophylline group. Future prospective studies of intraoperative aminophylline to prevent cardiac surgery-associated acute kidney injury may be warranted.

Figure 1

Comparative urine outputs (mL/kg/hr) of the intervention groups for the first postoperative 8 hours.

Figure 2

Mean urine outputs (mL/kg/hr) at postoperative 48 hr based on group assignment and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 score.

Figure 3

Comparison of mean δ serum creatinine values (percent change of creatinine compared to preoperative baseline serum creatinine) at discharge from PICU for the two intervention groups, according to their Risk Adjustment for Congenital Heart Surgery (RACHS)-1 score classifications.