Journal of Shanghai Jiao Tong University (Medical Science) >

2022 , Vol. 42 >Issue 1: 95 - 100

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.01.014

Evidence-based medicine

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

  • Dewei QIAN ,
  • Ren ZHOU ,
  • Lichun GUAN ,
  • Hang ZHANG ,
  • Min YU
Expand
  • 1.Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
    2.Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
YU Min, E-mail: minyudr@163.com.

Received date: 2021-04-14

  Online published: 2022-01-28

Supported by

Clinical Research Plan of Shanghai Shenkang Hospital Development Center (2020?2022)(SHDC2020CR3100B)

Fold

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

Cite this article

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 Jiao Tong University (Medical Science), 2022 , 42(1) : 95 -100 . DOI: 10.3969/j.issn.1674-8115.2022.01.014

References

1 GERMANN P, BRASCHI A, DELLA ROCCA G, et al. Inhaled nitric oxide therapy in adults: european expert recommendations[J]. Intensive Care Med, 2005, 31(8): 1029-1041.
2 GRIFFITHS M J, EVANS T W. Inhaled nitric oxide therapy in adults[J]. N Engl J Med, 2005, 353(25): 2683-2695.
3 GEBISTORF F, KARAM O, WETTERSLEV J, et al. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults[J]. Cochrane Database Syst Rev, 2016 (6): CD002787.
4 ZANG Y, POPAT K C, REYNOLDS M M. Nitric oxide-mediated fibrinogen deposition prevents platelet adhesion and activation[J]. Biointerphases, 2018, 13(6): 06E403.
5 LEI C, BERRA L, REZOAGLI E, et al. Nitric oxide decreases acute kidney injury and stage 3 chronic kidney disease after cardiac surgery[J]. Am J Respir Crit Care Med, 2018, 198(10): 1279-1287.
6 虞敏, 毛建强, 樊永亮, 等. 吸入一氧化氮治疗心脏直视手术后难治性低氧血症的疗效分析[J]. 上海交通大学学报(医学版), 2014, 34(3): 343-346, 351.
7 ZHANG H, LIU Y, MENG X, et al. Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study[J]. J Cardiothorac Surg, 2020, 15(1): 25.
8 PAGE M J, MCKENZIE J E, BOSSUYT P M, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews[J]. BMJ, 2021, 372: n71.
9 张天嵩. 经典meta分析统计模型的合理选择[J]. 中国循证医学杂志, 2020, 20(12): 1477-1481.
10 BRADBURN M J, DEEKS J J, BERLIN J A, et al. Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events[J]. Stat Med, 2007, 26(1): 53-77.
11 FERNANDES J L, SAMPAIO R O, BRAND?O C M, et al. Comparison of inhaled nitric oxide versus oxygen on hemodynamics in patients with mitral stenosis and severe pulmonary hypertension after mitral valve surgery[J]. Am J Cardiol, 2011, 107(7): 1040-1045.
12 POTAPOV E, MEYER D, SWAMINATHAN M, et al. Inhaled nitric oxide after left ventricular assist device implantation: a prospective, randomized, double-blind, multicenter, placebo-controlled trial[J]. J Heart Lung Transplant, 2011, 30(8): 870-878.
13 PERRIN G, ROCH A, MICHELET P, et al. Inhaled nitric oxide does not prevent pulmonary edema after lung transplantation measured by lung water content: a randomized clinical study[J]. Chest, 2006, 129(4): 1024-1030.
14 KAMENSHCHIKOV N O, MANDEL I A, PODOKSENOV Y K, et al. Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery: randomized trial[J]. J Thorac Cardiovasc Surg, 2019, 157(6): 2328-2336.
15 LANG J D, SMITH A B, BRANDON A, et al. A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation[J]. PLoS One, 2014, 9(2): e86053.
16 KAMENSHCHIKOV N O, ANFINOGENOVA Y J, KOZLOV B N, et al. Nitric oxide delivery during cardiopulmonary bypass reduces acute kidney injury: a randomized trial[J]. J Thorac Cardiovasc Surg, 2020. DOI: 10.1016/j.jtcvs.2020.03.182.
17 PALMER R M, FERRIGE A G, MONCADA S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor[J]. Nature, 1987, 327(6122): 524-526.
18 PEPKE-ZABA J, HIGENBOTTAM T W, DINH-XUAN A T, et al. Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension[J]. Lancet, 1991, 338(8776): 1173-1174.
19 ADHIKARI N K, BURNS K E, FRIEDRICH J O, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis[J]. BMJ, 2007, 334(7597): 779.
20 TRONCY E, FRANCOEUR M, SALAZKIN I, et al. Extra-pulmonary effects of inhaled nitric oxide in swine with and without phenylephrine[J]. Br J Anaesth, 1997, 79(5): 631-640.
21 NEUGARTEN J, SANDILYA S, SINGH B, Et al. Sex and the risk of AKI following cardio-thoracic surgery: a meta-analysis[J]. Clin J Am Soc Nephrol, 2016, 11(12): 2113-2122.
22 张航, 吴昀璋, 陈文, 等. 冠状动脉旁路移植术后急性肾损伤患者的预后分析: 基于多中心的中期随访研究[J]. 中国心血管病研究, 2021, 19(5): 414-420.
23 VERMEULEN WINDSANT I C, DE WIT N C, SERTORIO J T, et al. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage[J]. Front Physiol, 2014, 5: 340.
24 VERMEULEN WINDSANT I C, SNOEIJS M G, HANSSEN S J, et al. Hemolysis is associated with acute kidney injury during major aortic surgery[J]. Kidney Int, 2010, 77(10): 913-920.
25 BORETTI F S, BUEHLER P W, D'AGNILLO F, et al. Sequestration of extracellular hemoglobin within a haptoglobin complex decreases its hypertensive and oxidative effects in dogs and guinea pigs[J]. J Clin Invest, 2009, 119(8): 2271-2280.
26 BAEK J H, D'AGNILLO F, VALLELIAN F, et al. Hemoglobin-driven pathophysiology is an in vivo consequence of the red blood cell storage lesion that can be attenuated in guinea pigs by haptoglobin therapy[J]. J Clin Invest, 2012, 122(4): 1444-1458.
27 DEININGER S, HOENICKA M, MüLLER-EISING K, et al. Renal function and urinary biomarkers in cardiac bypass surgery: a prospective randomized trial comparing three surgical techniques[J]. Thorac Cardiovasc Surg, 2016, 64(7): 561-568.
28 MAMIKONIAN L S, MAMO L B, SMITH P B, et al. Cardiopulmonary bypass is associated with hemolysis and acute kidney injury in neonates, infants, and children[J]. Pediatr Crit Care Med, 2014, 15(3): e111-e119.
29 VERMEULEN WINDSANT I C, HANSSEN S J, BUURMAN W A, et al. Cardiovascular surgery and organ damage: time to reconsider the role of hemolysis[J]. J Thorac Cardiovasc Surg, 2011, 142(1): 1-11.
30 MA G G, HAO G W, LAI H, ET al. Initial clinical impact of inhaled nitric oxide therapy for refractory hypoxemia following type A acute aortic dissection surgery[J]. J Thorac Dis, 2019, 11(2): 495-504.
31 RI H S, SON H J, OH H B, et al. Inhaled nitric oxide therapy was not associated with postoperative acute kidney injury in patients undergoing lung transplantation: a retrospective pilot study[J]. Medicine (Baltimore), 2018, 97(22): e10915.
32 DEWHURST C, IBRAHIM H, G?THBERG S, ET al. Use of inhaled nitric oxide in the new born period: results from the european inhaled nitric oxide registry[J]. Acta Paediatr, 2010, 99(6): 854-860.
Options
Outlines

/

〈 〉