Meta-analysis of impacts of inhaled nitric oxide on postoperative renal injury and hemorrhage

doi:10.3969/j.issn.1674-8115.2022.01.014

Abstract

Abstract: Objective

·To evaluate the effects of inhaled nitric oxide on renal injury and hemorrhage after surgery.

Methods

·China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), WanFang Data, PubMed, Embase, Web of Science and The Cochrane Library were searched systematically from the establishment of each database to March 26, 2021. “外科手术” and “一氧化氮” were used as Chinese keywords for retrieval. Correspondingly, the “nitric oxide”“surgical procedures, operative”“cardiac surgical procedures”“cardiac surgery” and “transplantation” were used as subject words and free words for searching. The literatures were screened according to the pre-established inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.3. The study end points were the incidences of renal injury and hemorrhage.

Results

·Seven literatures were included for analysis, with a total of 689 surgical patients. Of them, 337 received nitric oxide treatment and 352 received placebo treatment. Compared with the control group, patients treated with nitric oxide demonstrated a statistically difference in reducing the incidence of postoperative renal injury (RR= 0.75, 95%CI 0.61?0.92, P=0.005). There was no significant difference in the incidence of hemorrhage (RR=0.79, 95%CI 0.22?2.83, P=0.710) between the two groups.

Conclusion

·Application of nitric oxide after surgery does not increase the risks of renal injury and hemorrhage. In contrast, the use of nitric oxide in cardiopulmonary bypass might protect renal function.

Key words: nitric oxide, renal injury, hemorrhage, surgery, meta-analysis

CLC Number:

R619⁺.9

Dewei QIAN, Ren ZHOU, Lichun GUAN, Hang ZHANG, Min YU. Meta-analysis of impacts of inhaled nitric oxide on postoperative renal injury and hemorrhage[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 95-100.

Figures/Tables 6

TrendMD

References 32

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Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	No. of AKI/ No. of cases/n
Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	NO	Control
PERRIN （2006）^［13］	Adults，lung transplantation	20 ppm within 12 h，through inhalation	Placebo	Need for RRT	1/15	1/15
POTAPOV （2011）^［12］	Adults，LVAD placement	40 ppm within 48 h，through inhalation	Placebo	Need for RRT	10/73	8/77
FERNANDES （2011）^［11］	Adults，mitral stenosis and severe pulmonary hypertension	10 ppm within 48 h，through inhalation	Oxygen	Urine output <0.3 mL·kg^-1·h^-1	0/14	1/15
LANG （2014）^［15］	Adults，liver transplantation	80 ppm during liver transplantation，through inhalation	Nitrogen	Urine output <0.3 mL·kg^-1·h^-1	3/40	7/40
LEI （2018）^［5］	Adults， multiple valve replacement surgery	80 ppm within 24 h，through CPB and inhalation	Placebo	KDIGO criteria （SCr only）	58/117	81/127
KAMENSHCHIKOV （2019）^［14］	Adults， CABG	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr only）	1/30	3/30
KAMENSHCHIKOV （2020）^［16］	Adults， CABG， valve surgery， surgical reconstruction of the left ventricle	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr and urine output）	10/48	20/48

Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	No. of AKI/ No. of cases/n
Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	NO	Control
PERRIN （2006）^［13］	Adults，lung transplantation	20 ppm within 12 h，through inhalation	Placebo	Need for RRT	1/15	1/15
POTAPOV （2011）^［12］	Adults，LVAD placement	40 ppm within 48 h，through inhalation	Placebo	Need for RRT	10/73	8/77
FERNANDES （2011）^［11］	Adults，mitral stenosis and severe pulmonary hypertension	10 ppm within 48 h，through inhalation	Oxygen	Urine output <0.3 mL·kg^-1·h^-1	0/14	1/15
LANG （2014）^［15］	Adults，liver transplantation	80 ppm during liver transplantation，through inhalation	Nitrogen	Urine output <0.3 mL·kg^-1·h^-1	3/40	7/40
LEI （2018）^［5］	Adults， multiple valve replacement surgery	80 ppm within 24 h，through CPB and inhalation	Placebo	KDIGO criteria （SCr only）	58/117	81/127
KAMENSHCHIKOV （2019）^［14］	Adults， CABG	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr only）	1/30	3/30
KAMENSHCHIKOV （2020）^［16］	Adults， CABG， valve surgery， surgical reconstruction of the left ventricle	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr and urine output）	10/48	20/48

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