natriuretic-peptide--brain and Oliguria

We evaluated the use of nesiritide in children with critical congenital heart disease, pulmonary congestion, and inadequate urine output despite conventional diuretic therapy.. We conducted a retrospective analysis of 26 consecutive patients, comprising 37 infusions occurring during separate hospitalizations. Hemodynamic variables, urine output, and serum creatinine levels were monitored prior to and throughout the duration of therapy with nesiritide. In addition, the stage of acute kidney injury was determined prior to and throughout the duration of the therapy using a standardized definition of acute kidney injury-The Kidney Disease: Improving Global Outcomes criteria.. Cardiac ICU.. Pediatric patients with critical congenital heart disease, pulmonary congestion, and inadequate urinary output despite diuretic therapy.. Nesiritide infusion.. The use of nesiritide was associated with a significant decrease in the central venous pressure and heart rate with a trend toward a significant increase in urine output. During the course of therapy with nesiritide, the serum creatinine and stage of acute kidney injury decreased significantly. The decrease in stage of acute kidney injury became significant by day 4 (p = 0.006) and became more significant with time (last day of therapy compared with baseline; p < 0.001). During 12 of the 37 infusions, the stage of acute kidney injury decreased by two or more (p < 0.001).. Nesiritide had a favorable impact on hemodynamics and urine output in children with critical congenital heart disease and pulmonary congestion, and there was no worsening of renal function.

Topics: Acute Kidney Injury; Drug Administration Schedule; Female; Heart Defects, Congenital; Heart Rate; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Kidney; Male; Natriuretic Agents; Natriuretic Peptide, Brain; Oliguria; Retrospective Studies; Severity of Illness Index; Treatment Outcome

Although nesiritide has been used in adults with left heart failure, the experience in the paediatric population is limited. We reviewed and analysed our experience with continuous nesiritide infusion as adjunct therapy in children with biventricular dysfunction due to diverse aetiologies and suffering from oliguria despite intravenous diuretics and inotropic therapies for heart-failure management.

Topics: Adolescent; Child; Critical Illness; Heart Failure; Humans; Infant; Male; Natriuretic Agents; Natriuretic Peptide, Brain; Oliguria; Ventricular Dysfunction

Cardiovascular dysfunction in patients with hemolytic-uremic syndrome (HUS) may be related to secondary issues such as volume overload, hypertension or electrolyte disturbances including hyperkalemia. Additionally, primary myocardial involvement has been increasingly recognized as a potential comorbid feature of HUS. We report a 9-month-old child with HUS who developed clinical signs of poor myocardial function with depressed myocardial function noted by echocardiography. Supportive care including mechanical ventilation and inotropic agents were necessary for approximately 10 days. Follow-up echocardiography revealed return of normal ventricular function. Previous reports of primary cardiac involvement with HUS have included thrombotic microangiopathy of the coronary vasculature resulting in myocardial ischemia, myocardial infarction or depressed myocardial function, myocarditis, congestive heart failure with dilated cardiomyopathy and pericardial effusion with tamponade. Given the potential for morbidity and mortality during the preoperative period in patients with HUS, anesthesiologists involved in the care of such patients should be aware of the potential for myocardial involvement in this disease process. Preoperatively, the routine evaluation of myocardial function may be indicated.

Topics: Anemia; Anti-Bacterial Agents; Cardiomyopathies; Cardiotonic Agents; Dopamine; Electrocardiography; Hemolytic-Uremic Syndrome; Humans; Infant; Intubation, Intratracheal; Male; Meropenem; Milrinone; Natriuretic Agents; Natriuretic Peptide, Brain; Oliguria; Peritoneal Dialysis; Renal Dialysis; Renal Insufficiency; Respiration, Artificial; Thienamycins; Vancomycin

Recombinant human brain natriuretic peptide, nesiritide, has recently been used in limited studies to enhance postoperative diuresis. A retrospective chart review was conducted at a university hospital to assess the efficacy of nesiritide in cardiac surgery patients with fluid overload refractory to diuretics and dopamine. Nine out of 137 patients who underwent coronary artery bypass grafting at the institution from May 2003 to July 2004 exhibited fluid overload despite diuretics and dopamine. Those who did not respond to the therapy, as manifested by oliguria and heart failure, were started on nesiritide. Urine output, weight change, central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), and serum creatinine were the main outcome measures. Within 6 hours after initiation of nesiritide, the average urine output increased from 28 to 130 mL/h. Serum creatinine levels were not significantly different after 24 hours. The mean CVP decreased from 14 to 10 within 12 hours while the PAWP decreased from 24 to 17 mm Hg. Systemic pressures did not change. One patient had to eventually undergo hemodialysis for complications of renal failure. Our experience demonstrates that infusion of nesiritide in patients with heart failure and fluid overload improves diuresis and hemodynamics without major side effects.

Topics: Coronary Artery Bypass; Diuretics; Heart Failure; Humans; Natriuretic Peptide, Brain; Oliguria; Retrospective Studies; Treatment Outcome