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The use of nesiritide in patients with critical cardiac disease

Published online by Cambridge University Press:  23 June 2017

Ronald A. Bronicki ,
Michele Domico ,
Paul A. Checchia ,
Curtis E. Kennedy  and
Ayse Akcan-Arikan
Ronald A. Bronicki*
Affiliation:
Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Michele Domico
Affiliation:
Section of Pediatric Critical Care Medicine, Children’s Hospital of Orange County, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
Paul A. Checchia
Affiliation:
Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Curtis E. Kennedy
Affiliation:
Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Ayse Akcan-Arikan
Affiliation:
Section of Pediatric Critical Care Medicine and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: R. A. Bronicki, MD, Section of Pediatric Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, W6006, 6621 Fannin Street, Houston, TX 77030, United States of America. Tel: 832 826 6214, Fax: +832 825 7422, E-mail: Bronicki@bcm.edu
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Abstract

Objective

We evaluated the use of nesiritide in children with critical CHD, pulmonary congestion, and inadequate urine output despite undergoing conventional diuretic therapy.

Design

We conducted a retrospective analysis of 11 patients with critical CHD, comprising 18 infusions, each of which occurred during separate hospitalisations. Haemodynamic parameters were assessed, and the stage of acute kidney injury was determined before and throughout the duration of therapy using a standardised definition of acute kidney injury – The Kidney Disease: Improving Global Outcomes criteria.

Patients

Children with critical CHD, pulmonary congestion, and inadequate urinary output despite undergoing diuretic therapy were included.

Measurements and main results

The use of nesiritide was associated with a significant decrease in the maximum and minimum heart rate values and with a trend towards a significant decrease in maximum systolic blood pressure and maximum and minimum central venous pressures. Urine output increased but was not significant. Serum creatinine levels decreased significantly during the course of therapy (−0.26 mg/dl [−0.50, 0.0], p=0.02), and the number of patients who experienced a decrease in the stage of acute kidney injury of 2 or more – where a change in the stage of acute kidney disease of 2 or more was possible, that is, baseline stage >1 – was highly significant (five of 12 patients, 42%, p<0.001).

Conclusions

Nesiritide had a favourable impact on haemodynamics, and its use was not associated with deterioration of renal function in patients with critical CHD.

Keywords

Nesiritide, CHDsingle-ventricle physiologyacute kidney injury
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1577 - 1584
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Copyright
© Cambridge University Press 2017 

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