Acetaminophen Attenuates Lipid Peroxidation in Children Undergoing Cardiopulmonary Bypass

作者：Simpson Scott A; Zaccagni Hayden; Bichell David P; Christian Karla G; Mettler Bret A; Donahue Brian S; Roberts L Jackson II; Pretorius Mias^*

来源：Pediatric Critical Care Medicine, 2014, 15(6): 503-510.

DOI：10.1097/PCC.0000000000000149

• acetaminophen
• acute kidney injury
• cardiac surgery
• cardiopulmonary bypass
• hemoglobin
• lipid peroxidation
• pediatrics

Objective: Hemolysis, occurring during cardiopulmonary bypass, is associated with lipid peroxidation and postoperative acute kidney injury. Acetaminophen inhibits lipid peroxidation catalyzed by hemeproteins and in an animal model attenuated rhabdomyolysis-induced acute kidney injury. This pilot study tests the hypothesis that acetaminophen attenuates lipid peroxidation in children undergoing cardiopulmonary bypass.
Design: Single-center prospective randomized double-blinded study.
Setting: University-affiliated pediatric hospital.
Patients: Thirty children undergoing elective surgical correction of a congenital heart defect.
Interventions: Patients were randomized to acetaminophen (OFIRMEV [acetaminophen] injection; Cadence Pharmaceuticals, San Diego, CA) or placebo every 6 hours for four doses starting before the onset of cardiopulmonary bypass.
Measurement and Main Results: Markers of hemolysis, lipid peroxidation (isofurans and F-2-isoprostanes), and acute kidney injury were measured throughout the perioperative period. Cardiopulmonary bypass was associated with a significant increase in free hemoglobin (from a prebypass level of 9.8 +/- 6.2 mg/dL to a peak of 201.5 +/- 42.6 mg/dL postbypass). Plasma and urine isofuran and F-2-isoprostane concentrations increased significantly during surgery. The magnitude of increase in plasma isofurans was greater than the magnitude in increase in plasma F-2-isoprostanes. Acetaminophen attenuated the increase in plasma isofurans compared with placebo (p = 0.02 for effect of study drug). There was no significant effect of acetaminophen on plasma F-2-isoprostanes or urinary makers of lipid peroxidation. Acetaminophen did not affect postoperative creatinine, urinary neutrophil gelatinase-associated lipocalin, or prevalence of acute kidney injury.
Conclusion: Cardiopulmonary bypass in children is associated with hemolysis and lipid peroxidation. Acetaminophen attenuated the increase in plasma isofuran concentrations. Future studies are needed to establish whether other therapies that attenuate or prevent the effects of free hemoglobin result in more effective inhibition of lipid peroxidation in patients undergoing cardiopulmonary bypass.

• 出版日期2014-7