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Radel LJ, Branstetter J, Jones TL, Briceno-Medina M, Tadphale SD, Onder AM, Rayburn MS. Use of Aminophylline to Reverse Acute Kidney Injury in Pediatric Critical Care Patients. J Pediatr Pharmacol Ther 2022; 27:739-745. [DOI: 10.5863/1551-6776-27.8.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE
Acute kidney injury (AKI) is a complication encountered in 18% to 51% of pediatric critical care patients admitted for treatment of other primary diagnoses and is an independent risk factor for increased morbidity and mortality. Aminophylline has shown promise as a medication to treat AKI, but published studies have shown conflicting results. Our study seeks to assess the reversal of AKI following the administration of aminophylline in critically ill pediatric patients.
METHODS
We performed a single-institution retrospective chart review of pediatric inpatients who were diagnosed with AKI and subsequently treated with non-continuous dose aminophylline between January 2016 and December 2018. Data were collected beginning 2 days prior to the initial dose of aminophylline through completion of the 5-day aminophylline course.
RESULTS
Nineteen therapies among 17 patients were included in analysis. Twelve of the therapies resulted in resolution of AKI during the study period. We observed urine output increase of 19% (p = 0.0063) on the day following initiation of aminophylline therapy in the subset of patients whose AKI resolved. Trends toward decreased serum creatinine and lower inotropic support were also noted.
CONCLUSIONS
Based on these findings, aminophylline could be considered a potentially effective medication for use as rescue therapy in critically ill children with AKI. Limitations include small study population and retrospective nature. Further research in this area with a larger study population and a randomized control trial would allow for better characterization of the efficacy of aminophylline in reversal of AKI.
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Affiliation(s)
- Laura J. Radel
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Joshua Branstetter
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Tamekia L. Jones
- Department of Pediatrics and Preventive Medicine (TLJ), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Sachin D. Tadphale
- Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
| | - Ali Mirza Onder
- Department of Nephrology (AMO), Children's of Mississippi and University of Mississippi Medical Campus, Jackson, MS
| | - Mark S. Rayburn
- Department of Pharmacy (MSR), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN
- Department of Clinical Pharmacy and Translational Science (MSR), University of Tennessee Health Science Center and Children's Foundation Research Institute, Memphis, TN
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Paudel G, Johnson JN, Philip R, Tailor N, Fahnhorst S, Briceno-Medina M, Stecchi N, Waller BR, Sathanandam S. Echocardiographic versus Angiographic Measurement of the Patent Ductus Arteriosus in Extremely Low Birth Weight Infants and the Utility of Echo Guidance for Transcatheter Closure. J Am Soc Echocardiogr 2021; 34:1086-1094. [PMID: 34139301 DOI: 10.1016/j.echo.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is increasingly utilized for guiding transcatheter closure of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objectives of this study were to compare PDA size measurements by TTE with angiographic measurements and to describe TTE techniques used in guiding transcatheter PDA closure (TCPC) in ELBW infants. METHODS One hundred twenty-five consecutive ELBW infants (gestational age < 27 weeks, birth weight < 1 kg) who underwent TCPC before 8 weeks of age under TTE guidance were included. Patent ductus arteriosus sizes were measured from the procedural TTE and angiograms retrospectively by blinded observers. The TTE PDA diameters at the aortic (ED1) and pulmonary end (ED2) were compared with the corresponding angiographic diameters (CD1 and CD2). The TTE PDA lengths, obtained by two techniques (EL1, a straight line between ED1 and ED2; and EL2, a curvilinear line along the PDA), were compared with the PDA length by angiography (CL). Transthoracic echocardiography was used to guide accurate device positioning within the PDA. RESULTS The procedure weight was 600-1,460 g. The TTE and angiographic PDA diameters were comparable (mean ED1 vs CD1 = 4.5 ± 0.68 vs 4.4 ± 0.85 mm, P = .26; and mean ED2 vs CD2 = 3.1 ± 0.72 vs 3.2 ± 0.94 mm, P = .14). The angiographic length was underestimated by EL1 by 2.6 ± 1.6 mm (P < .0001), while EL2 estimated it better (mean EL2 vs CL = 11.0 ± 1.83 vs 10.8 ± 2.15 mm; P = .40). Transcatheter PDA closure was successful in 100% of the cases using TTE guidance. There were no intraprocedural complications. CONCLUSIONS Transthoracic echocardiography guidance during TCPC in ELBW infants eliminates the need for aortograms via femoral arterial access, preventing the complications associated with it. Transthoracic echocardiography PDA measurements are comparable to angiographic measurements, thereby assisting in appropriate device size selection.
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Affiliation(s)
- Govinda Paudel
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Jason N Johnson
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pediatric Radiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ranjit Philip
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Neil Tailor
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sarah Fahnhorst
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mario Briceno-Medina
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nathan Stecchi
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - B Rush Waller
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Shyam Sathanandam
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
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Briceno-Medina M, Kumar TS. Right ventricle-to-pulmonary artery conduit in Norwood operation: a work in progress. Eur J Cardiothorac Surg 2020; 59:ezaa278. [PMID: 32864687 DOI: 10.1093/ejcts/ezaa278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mario Briceno-Medina
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tk Susheel Kumar
- Department of Congenital Cardiothoracic Surgery, NYU Langone Health, New York, NY, USA
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Kumar TKS, Zurakowski D, Briceno-Medina M, Shah A, Sathanandam S, Allen J, Sandhu H, Joshi VM, Boston U, Knott-Craig CJ. Experience of a single institution with femoral vein homograft as right ventricle to pulmonary artery conduit in stage 1 Norwood operation. J Thorac Cardiovasc Surg 2019; 158:853-862.e1. [PMID: 31204139 DOI: 10.1016/j.jtcvs.2019.03.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Femoral vein homograft can be used be used as valved right ventricle to pulmonary artery conduit in the Norwood operation. We describe the results of this approach, including pulmonary artery growth and ventricular function. METHODS A retrospective chart review of 24 consecutive neonates with hypoplastic left heart syndrome or complex single ventricle undergoing this approach between June 2012 and December 2017 was performed. Conduit valve competency and ventricular function were estimated using transthoracic echocardiogram, and pulmonary artery growth was measured using Nakata's index. Changes in ventricular function pre-Glenn and at latest follow-up were assessed by ordinal logistic regression with a general linear model to account for the correlation within the same patient over time. RESULTS Median age at surgery was 4 days, and mean weight was 3 kg. There was no interstage mortality. A total of 21 patients have undergone Glenn operation, and 9 patients have completed the Fontan operation. None of the conduits developed thrombosis. Sixty-three percent of conduits remained competent in the first month, and 33% remained competent after 3 months of operation. Catheter interventions on conduits were necessary in 14 patients. Median Nakata index at pre-Glenn catheterization was 228 mm2/m2 (interquartile range, 107-341 mm2/m2). Right ventricular function was preserved in 83% of patients at a median follow-up of 34 (interquartile range, 10-46) months. CONCLUSIONS Femoral vein homograft as a right ventricle to pulmonary artery conduit in the Norwood operation is safe and associated with good pulmonary artery growth and preserved ventricular function as assessed by subjective echocardiography. Catheter intervention of the conduit may be necessary.
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Affiliation(s)
- T K Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Aditya Shah
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Shyam Sathanandam
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Jerry Allen
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Hitesh Sandhu
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Vijaya M Joshi
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Umar Boston
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Christopher J Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
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Kumar TKS, Briceno-Medina M, Khan AH, Knott-Craig CJ. Right ventricle-to-pulmonary artery conduit for surgical management of transposition of great arteries with a complex coronary pattern. J Thorac Cardiovasc Surg 2017. [PMID: 28648333 DOI: 10.1016/j.jtcvs.2017.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T K Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
| | - Mario Briceno-Medina
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Abdul H Khan
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
| | - Christopher J Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn
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Perez M, Kumar TKS, Briceno-Medina M, Knott-Craig CJ. Partial Anomalous Pulmonary Venous Connection to the Azygous Vein: Unusual Pathology Requiring Unusual Repair. Ann Thorac Surg 2016; 102:e41-2. [PMID: 27343528 DOI: 10.1016/j.athoracsur.2015.11.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
Abstract
Connection of the right pulmonary veins to the azygous is an extremely rare variant of partial anomalous pulmonary venous connection. We describe one such case in the setting of an intact atrial septum. Surgical correction in such a situation can be challenging. We describe a successful surgical approach for this unusual variant.
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Affiliation(s)
- Michael Perez
- Division of Pediatric Cardiology, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee.
| | - T K Susheel Kumar
- Division of Pediatric Cardiac Surgery, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Mario Briceno-Medina
- Division of Pediatric Cardiology, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Christopher J Knott-Craig
- Division of Pediatric Cardiac Surgery, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
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Kimura D, Briceno-Medina M, Kumar TKS, Knott-Craig CJ. Severe Pulmonary Vascular Obstructive Disease After Neonatal Arterial Switch Operation for Simple Transposition of the Great Arteries. World J Pediatr Congenit Heart Surg 2016; 8:114-116. [PMID: 27098605 DOI: 10.1177/2150135115623288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal arterial switch operation for simple dextro-transposition of the great arteries (d-TGA) has almost eliminated the occurrence of pulmonary vascular obstructive disease compared to patients who underwent Mustard or Senning procedure at an older age. We report a case of a neonate with d-TGA and intact ventricular septum who underwent arterial switch operation and yet developed severe pulmonary vascular obstructive disease within two months.
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Affiliation(s)
- Dai Kimura
- 1 Department of Pediatrics, Divisions of Pediatric Critical Care, University of Tennessee Health Sciences Center and Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Mario Briceno-Medina
- 2 Pediatric Cardiology, University of Tennessee Health Sciences Center and Le Bonheur Children's Hospital, Memphis, TN, USA
| | - T K Susheel Kumar
- 3 Cardiovascular Surgery, University of Tennessee Health Sciences Center and Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christopher J Knott-Craig
- 3 Cardiovascular Surgery, University of Tennessee Health Sciences Center and Le Bonheur Children's Hospital, Memphis, TN, USA
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Perez M, Kumar TS, Briceno-Medina M, Akkhawattanangkul Y, Allen K, Knott-Craig C, Waller B, Sathanandam S. ENDOVASCULAR DE-BANDING OF PULMONARY ARTERIES IN A SWINE MODEL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kimura D, Shah S, Briceno-Medina M, Sathanandam S, Haberman B, Zhang J, Myers L, Kumar TS, Knott-Craig C. Management of massive diffuse alveolar hemorrhage in a child with systemic lupus erythematosus. J Intensive Care 2015; 3:10. [PMID: 27213047 PMCID: PMC4874015 DOI: 10.1186/s40560-015-0076-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/13/2015] [Indexed: 12/18/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) from systemic lupus erythematosus (SLE) is a rare but potentially life-threatening condition. We report the case of a 14-year-old female with SLE who developed hypoxia and shock secondary to severe alveolar hemorrhage. She was successfully managed by placement on extracorporeal membrane oxygenation (ECMO) followed by emergent pulmonary lobectomy and medical treatment including high-dose methylprednisolone, cyclophosphamide, intravenous immunoglobulin, and plasmapheresis.
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Affiliation(s)
- Dai Kimura
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, TN Memphis, 38103 USA
| | - Samir Shah
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, TN Memphis, 38103 USA ; Department of ECMO/Apheresis, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Mario Briceno-Medina
- Department of Cardiology, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Shyam Sathanandam
- Department of Cardiology, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Brent Haberman
- Department of Pulmonology, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Jie Zhang
- Department of Pathology, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Linda Myers
- Department of Rheumatology, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Tk Susheel Kumar
- Department of Cardiovascular Surgery, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
| | - Christopher Knott-Craig
- Department of Cardiovascular Surgery, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, Memphis, TN USA
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