Open AccessInfluence of fluid overload in the post-operative period in newborns on the development of acute renal injury and duration of ICU stay
Author(s) -
L.S. Zolotareva,
Золотарева Любовь Святославовна,
Vladimir V. Khorev,
Хорев Владимир Владимирович,
A.I. Makulova,
Макулова Анастасия Ивановна,
Сергей Михайлович Степаненко,
Степаненко Сергей Михайлович,
E.V. Zilbert,
Зильберт Елена Витальевна,
T.O. Svetlichnaya,
Светличная Татьяна Олеговна
Publication year - 2020
Publication title -
rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii
Language(s) - English
Resource type - Journals
eISSN - 2587-6554
pISSN - 2219-4061
DOI - 10.17816/psaic649
Subject(s) - medicine , acute kidney injury , necrotizing enterocolitis , intensive care unit , volume overload , anesthesia , heart failure
Aim. To identify the relationship between fluid overload in children who received infusion therapy in the postoperative period at surgical intensive care unit (ICU), the development of acute kidney injury (AKI), and the length of ICU stay.
Methods. A retrospective cohort observational study was conducted. Our study includes 75 newborns with malformations of the gastrointestinal tract, diaphragmatic hernias, gastroschisis, necrotizing enterocolitis and sacrococcygeal teratomas treated after surgery in the ICU. The Kidney Disease: Improving Global Outcomes (nKDIGO) scale was used to detect AKI. To assess the fluid overload, the ratio of the difference between the introduced and released liquid and entering the ICU weight was used (in %). Significant overload was adopted value more than 5%. The indicator injected fluid consisted of the volume of infusion and enteral nutrition. The indicator of released fluid included diuresis, fluid loss from the gastrointestinal tract, intestinal stomas, and drainages.
Results. The frequency of AKI was 28.0% (21 of 75). The average time of AKI development from the moment of surgical intervention was 5.9 3.29 days. The duration of ICU stay after surgery was 8.0 [5.0; 16.0] days. In 18 of 75 (24%) children, the fluid overload of more than 5% was observed on the 1st postoperative day. In 12 out of 75 (16%) children, the fluid overload of more than 5% was observed on the 2nd postoperative day. A fluid overload of more than 5%, observed on the 1st day after the operation, was associated with a longer ICU stay. The rate of AKI is higher when a fluid overload of more than 5% on the 2nd day after surgery was observed.
Conclusion. Severe fluid overload can be a significant factor of the AKI development. Fluid overload more then 5% on the 2nd day after surgery may lead to an increase in the incidence of AKI. Liquid overload more then 5% on the 1st day after surgery may lead to an increase in the length of ICU stay. In newborns, it is necessary to take into account the fluid load at the first two days after the operation and correct the infusion therapy in case of fluid overload detection.