Prospective quality improvement study finds no reduction in acute kidney injury among pediatric heart surgery patients, suggesting intensive care bundles alone may be insufficient.
Key Points
To determine whether a bundled intervention could decrease the incidence of postoperative acute kidney injury from a baseline of 41% to under 30% in pediatric cardiac surgery patients.
Conducted a prospective multicenter quality improvement project across five pediatric cardiac intensive care units including patients <18 years undergoing STAT ≥3 or Fontan operations (N=599 baseline, N=480 implementation).
Implemented a five-part bundle comprising daily creatinine monitoring with staging, balanced IV fluids, scheduled acetaminophen, age-appropriate renal perfusion pressure targets, and nephrotoxin avoidance.
Aggregate baseline incidence was 41% for any acute kidney injury and 15% for severe acute kidney injury.
Despite adequate adherence to the bundle components, no reduction was observed in either the incidence or severity of postoperative acute kidney injury.
Patients managed during the bundle implementation period underwent cardiac transplantation significantly more often than baseline controls (10.0% vs. 5.8%, p=0.01).