• David M Kwiatkowski, David M Axelrod, Scott M Sutherland, Tiffany M Tesoro, and Catherine D Krawczeski.
• 1Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 2Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 3Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
• Pediatr Crit Care Me. 2015 Dec 15.

ObjectivesRecent data have suggested an association between the use of dexmedetomidine and a decreased incidence of acute kidney injury in adult patients after cardiopulmonary bypass. However, no study has focused on this association among pediatric populations where the incidence of acute kidney injury is particularly high and of critical significance. The primary objective of this study was to assess the relationship between the use of postoperative dexmedetomidine and the incidence of acute kidney injury in pediatric patients undergoing cardiopulmonary bypass. The secondary objective was to determine whether there was an association between dexmedetomidine use and duration of mechanical ventilation or cardiovascular ICU stay.DesignSingle-center retrospective matched cohort study.SettingA 20-bed quaternary cardiovascular ICU in a university-based pediatric hospital in California.PatientsChildren less than 18 years old admitted after cardiac surgery with cardiopulmonary bypass between January 1, 2012, and May 31, 2014.InterventionsNone.Measurements And Main ResultsData from a cohort of 102 patients receiving dexmedetomidine during the first postoperative day after cardiac surgery were compared to an age- and procedure-matched cohort not receiving dexmedetomidine. Cohorts had similar baseline and demographic characteristics. Patients receiving dexmedetomidine were less likely to develop acute kidney injury (24% vs 36%; odds ratio, 0.54; 95% CI, 0.29-0.99; p = 0.046). After adjusting for age, bypass time, nephrotoxin use, and vasoactive inotropic score, the use of dexmedetomidine was associated with a lower incidence of acute kidney injury with adjusted odds ratio of 0.43 (95% CI, 0.27-0.98; p = 0.048). There was no difference between the cohorts with respect to the duration of mechanical duration (1 d each; p = 0.98) or cardiovascular ICU stays (5 vs 6 d; p = 0.91).ConclusionsThe use of a dexmedetomidine infusion in pediatric patients after congenital heart surgery was associated with a decreased incidence of acute kidney injury; however, it was not associated with changes in clinical outcomes. Further prospective study is necessary to validate these findings.

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