Background Multiple organ dysfunction syndrome (MODS) is an important cause of post-operative morbidity and mortality for children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Dysregulated inflammation is widely regarded as a key contributor to bypass-related MODS pathobiology, with considerable overlap of pathways associated with septic shock. The pediatric sepsis biomarker risk model (PERSEVERE) is comprised of seven protein biomarkers of inflammation and reliably predicts baseline risk of mortality and organ dysfunction among critically ill children with septic shock. We aimed to determine if PERSEVERE biomarkers and clinical data could be combined to derive a new model to assess the risk of persistent CPB-related MODS in the early post-operative period. Methods This study included 306 patients < 18 years old admitted to a pediatric cardiac ICU after surgery requiring cardiopulmonary bypass (CPB) for congenital heart disease. Persistent MODS, defined as dysfunction of two or more organ systems on postoperative day 5, was the primary outcome. PERSEVERE biomarkers were collected 4 and 12 h after CPB. Classification and regression tree methodology were used to derive a model to assess the risk of persistent MODS. Results The optimal model containing interleukin-8 (IL-8), chemokine ligand 3 (CCL3), and age as predictor variables had an area under the receiver operating characteristic curve (AUROC) of 0.86 (0.81–0.91) for differentiating those with or without persistent MODS and a negative predictive value of 99% (95–100). Ten-fold cross-validation of the model yielded a corrected AUROC of 0.75 (0.68–0.84). Conclusions We present a novel risk prediction model to assess the risk for development of multiple organ dysfunction after pediatric cardiac surgery requiring CPB. Pending prospective validation, our model may facilitate identification of a high-risk cohort to direct interventions and studies aimed at improving outcomes via mitigation of post-operative organ dysfunction.

OBJECTIVES:To evaluate the effect of implementation of a comfort algorithm on infusion rates of opioids and benzodiazepines in postneonatal postoperative pediatric cardiac surgery patients.DESIGN:A quality improvement project, using statistical process control methodology.SETTING:Twenty-five-bed tertiary care pediatric cardiac ICU in an urban academic Children's hospital.PATIENTS:Postoperative pediatric cardiac surgery patients.INTERVENTIONS:Implementation of a guided comfort medication algorithm which consisted of key components; a low dose opioid continuous infusion, judicious use of frequent as needed opioids, initiation of dexmedetomidine infusion postoperatively, and minimal use of benzodiazepines.MEASUREMENTS AND MAIN RESULTS:Among the baseline group admitted over the 18 month period prior to comfort algorithm implementation, 58 of 116 intubated patients (50%) received a continuous opioid infusion, compared with 30 of 41 (73%) for the implementation group over the 9-month period following implementation. Following algorithm implementation, opioid infusion rates were decreased and benzodiazepine infusions were nearly eliminated. Dexmedetomidine use and infusion rates did not change. Although mean duration of sedative drug infusions did not change with implementation, the frequency of high outliers was diminished. Duration of mechanical ventilation, length of ICU stay (outcome measures), and the frequency of unplanned extubation (balancing measure) were not affected by implementation.CONCLUSIONS:Implementation of a pediatric comfort algorithm reduced opioid and benzodiazepine dosing, without compromising safety for postoperative pediatric cardiac surgical patients.

Advances in surgical techniques, myocardial protection, and cardiac intensive care have all contributed to marked improvement in morbidity and mortality following congenital heart surgery. Despite these improvements, pediatric patients remain at high risk for developing a low cardiac output state and impaired systemic oxygen delivery, especially in the early postoperative period. This transient drop in cardiac output after cardiac surgery has been referred to as low cardiac output syndrome (LCOS). LCOS in the early postoperative period is primarily due to transient systolic and/or diastolic myocardial dysfunction, compounded by acute changes in myocardial loading conditions. Surgical repair of cardiac malformations exposes the myocardium to periods of ischemia and cardiopulmonary bypass (CPB)-mediated inflammation, resulting in transient myocardial injury. The inflammatory response after CPB also results in pulmonary dysfunction and alters pulmonary and systemic vascular reactivity (Hovels-Gurich et al., 2002; Boyle et al., 1997; Butler et al., 1996) [1], [2], [3]. Residual cardiac defects potentiate low cardiac output in the postoperative state. Although advances in myocardial protection, cardioplegia, and perfusion techniques have dramatically reduced CPB-mediated cardiovascular injury, even relatively simple cardiac procedures are persistently associated with measurable myocardial dysfunction (Chaturvedi et al., 1998) [4].

Importance Fluid overload after congenital heart surgery is frequent and a major cause of morbidity and mortality among infants. Many programs have adopted the use of peritoneal dialysis (PD) for fluid management; however, its benefits compared with those of traditional diuretic administration are unknown. Objective To determine whether infants randomized to PD vs furosemide for the treatment of oliguria have a higher incidence of negative fluid balance on postoperative day 1, as well as avoidance of 10% fluid overload; shorter duration of mechanical ventilation, intensive care unit stay, and inotrope use; and fewer electrolyte abnormalities. Design, Setting, and Participants This single-center, unblinded, randomized clinical trial compared methods of fluid removal after cardiac surgery from October 1, 2011, through March 13, 2015, in a large tertiary pediatric hospital in Ohio. The parents or guardians of all eligible infants (aged <6 months) undergoing cardiac surgery with catheter placement for PD were approached for inclusion. No patients were withdrawn for adverse effects. Recruitment was powered for the primary outcome, and analysis was based on intention to treat. Patients randomized to PD were hypothesized to have superior outcomes. Interventions Infants received intravenous furosemide (1 mg/kg every 6 hours) or a standardized PD regimen. Main Outcomes and Measures The primary end point was incidence of negative fluid balance on postoperative day 1. Secondary end points included incidence of fluid overload, duration of mechanical ventilation and intensive care unit stay, electrolyte abnormalities and repletion doses, duration of inotropic administration, and mortality. Results Seventy-three patients (47 boys [64%] and 26 girls [35%]; median age, 8 [interquartile range (IQR), 6-14] days) received treatment and completed the trial. No difference was found between the PD and furosemide groups in the incidence of negative fluid balance on the first postoperative day. The furosemide group was 3 times more likely to have 10% fluid overload (odds ratio [OR], 3.0; 95% CI, 1.3-6.9), was more likely to have prolonged ventilator use (OR, 3.1; 95% CI, 1.2-8.2), and had a longer duration of inotrope use (median, 5.5 [IQR, 4-8] vs 4.0 [IQR, 3-6] days) and higher electrolyte abnormality scores (median, 6 [IQR, 4-7] vs 3 [IQR, 2-5]) compared with the PD group. No statistically significant differences in mortality (3 patients [9.4%] in the furosemide group vs 1 patient [3.1%] in the PD group) or length of cardiac intensive care unit (median, 7 [IQR, 6-12] vs 9 [IQR, 5-15] days) or hospital (15 [IQR, 10-28] vs 14 [IQR, 9-22] days) stay were observed. No serious complications were observed. Dialysis was discontinued early in 9 of 41 patients in the PD group for pleural-peritoneal communication. Conclusions and Relevance Use of PD is safe and allows for superior fluid management with improved clinical outcomes compared with diuretic administration. Use of PD should be strongly considered among infants at high risk for postoperative acute kidney injury and fluid overload. Trial Registration clinicaltrials.gov Identifer:NCT01709227

Objective: Limited evidence exists on use of corticosteroids in low cardiac output syndrome following cardiac surgery. We sought to determine physicians’ practices and beliefs with regard to corticosteroids therapy for low cardiac output syndrome. Design: Multinational internet-based survey. Setting: Pediatric Cardiac Intensive Care Society member database. Subjects: Pediatric cardiac intensive care physicians. Interventions: None. Measurements and Main Results: We received 188 responses from 85 centers throughout the world including 57 U.S. congenital heart centers, eight Canadian centers, and 20 international centers. The majority of respondents (51%) reported performing at least 200 bypass cases per year and had separate dedicated cardiac ICUs (57%). Most physicians (89%) rarely or never prescribe corticosteroids for mild low cardiac output syndrome (single vasoactive agent and mildly decreased perfusion), whereas 94% of those surveyed sometimes or always administer corticosteroids to patients with severe low cardiac output syndrome (two or more vasoactive agents and persistent hypotension). Hydrocortisone was the most commonly used corticosteroids (88%), but there was no consensus on dosage used. There was a variable approach to cortisol level measurement and cortisol stimulation testing to inform therapy with corticosteroids. A majority of respondents (75%) stated that they would be willing to randomize patients with severe low cardiac output syndrome into a trial of corticosteroids efficacy. Conclusions: Our survey demonstrates considerable practice variability with regard to the type of patients in whom corticosteroids are administered, adrenal axis testing is performed, and dosage of hydrocortisone used. The majority of physicians, however, stated their willingness to randomize patients with severe low cardiac output syndrome in a corticosteroids trial. This survey identified multiple areas for future research on use of corticosteroids for low cardiac output syndrome.

AbstractObjectiveReports in the literature of treatment with recombinant tissue plasminogen activator following cardiac surgery are limited. We reviewed our experience to provide a case series of the therapeutic use of tissue plasminogen activator for the treatment of venous thrombosis in children after cardiac surgery. The data describe the morbidity, mortality, and clinical outcomes of tissue plasminogen activator administration for treatment of venous thrombosis in children following cardiac surgery.DesignThe study was designed as a retrospective case series.SettingThe study was carried out in a 25-bed cardiac intensive care unit in an academic, free-standing paediatric hospital.PatientsAll children who received tissue plasminogen activator for venous thrombosis within 60 days of cardiac surgery, a total of 13 patients, were included.InterventionsData was collected, collated, and analysed as a part of the interventions of this study.Measurements and main resultsPatients treated with tissue plasminogen activator were principally young infants (median 0.2, IQR 0.07–0.58 years) who had recently (22, IQR 12.5–27.3 days) undergone cardiac surgery. Hospital mortality was high in this patient group (38%), but there was no mortality attributable to tissue plasminogen activator administration, occurring within <72 hours. There was one major haemorrhagic complication that may be attributable to tissue plasminogen activator. Complete or partial resolution of venous thrombosis was confirmed using imaging in 10 of 13 patients (77%), and tissue plasminogen activator administration was associated with resolution of chylous drainage, with no drainage through chest tubes, at 10 days after tissue plasminogen activator treatment in seven of nine patients who had upper-compartment venous thrombosis-associated chylothorax.ConclusionsOn the basis of our experience with administration of tissue plasminogen activator in children after cardiac surgery, tissue plasminogen activator is both safe and effective for resolution of venous thrombosis in this high-risk population.

Myocardial contractility and relaxation are highly dependent on calcium homeostasis. Immature myocardium, as in pediatric patients, is thought to be more dependent on extracellular calcium for optimal function. For this reason, intravenous calcium chloride infusions may improve myocardial function in the pediatric patient. The objectives of this study were to report the hemodynamic changes seen after administration of continuous calcium chloride to critically ill children. We retrospectively identified pediatric patients (newborn to 17 years old) with hemodynamic instability admitted to the cardiac ICU between May 2011 and May 2012 who received a continuous infusion of calcium chloride. The primary outcome was improvement in cardiac output, assessed by arterial-mixed venous oxygen saturation (A–V) difference. Sixty-eight patients, mean age 0.87 ± 2.67 years, received a total of 116 calcium infusions. Calcium chloride infusions resulted in significant improvements in primary and secondary measures of cardiac output at 2 and 6 h. Six hours after calcium initiation, A–V oxygen saturation difference decreased by 7.4 % (32.6 ± 2.1 to 25.2 ± 2.0 %, p < 0.001), rSO2 increased by 5.5 % (63.1 vs 68.6 %, p < 0.001), and serum lactate decreased by 0.9 mmol/l (3.3 vs 2.4 mmol/l, p < 0.001) with no change in HR (149.1 vs 145.6 bpm p = 0.07). Urine output increased 0.66 ml/kg/h in the 8-h period after calcium initiation when compared to pre-initiation (p = 0.003). Neonates had the strongest evidence of effectiveness with other age groups trending toward significance. Calcium chloride infusions improve markers of cardiac output in a heterogenous group of pediatric patients in a cardiac ICU. Neonates appear to derive the most benefit from utilization of these infusions.

We present the case of a two-month-old male with congenital Gerbode defect, hypoplastic aortic arch, and left-sided partially anomalous pulmonary venous return. The patient underwent single-stage surgical repair, which consisted of aortic arch advancement with resection of the coarctation segment, pulmonary vein repair, and primary closure of the Gerbode defect. The anomalous pulmonary vein posed a particular challenge due to its size and distance from the left atrium, which we approached with a posterior atrial wall trapdoor baffle technique, without mobilizing the affected vein. Postoperatively and at one year followup, there was no evidence of residual lesions and there was unobstructed flow pattern across the aortic arch and the affected pulmonary vein.

Objectives: To improve communication during daily cardiac ICU multidisciplinary rounds. Design: Quality improvement methodology. Setting: Twenty-five–bed cardiac ICUs in an academic free-standing pediatric hospital. Patients: All patients admitted to the cardiac ICU. Interventions: Implementation of visual display of patient daily goals through a write-down and read-back process. Measurements and Main Results: The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1–6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6–5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. Conclusions: Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.

AbstractWe hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.

Background: Acute kidney injury (AKI) is common in infants after cardiopulmonary bypass and is associated with poor outcomes. Peritoneal dialysis improves outcomes in adults with AKI after bypass, but pediatric data are limited. This retrospective case-matched study was conducted to determine if the practice of peritoneal dialysis catheter (PDC) placement during congenital heart surgery is associated with improved clinical outcomes in infants at high risk for AKI.Methods: Forty-two infants undergoing congenital heart surgery with planned PDC placement (PDC+) were age-matched to infants undergoing similar surgery without PDC placement (PDC-). Demographic, baseline and outcome data were compared. Our primary outcome was negative fluid balance on postoperative days 1 to 3. Secondary outcomes included time to negative fluid balance, time to extubation, frequency of electrolyte corrective medications, inotrope scores, and other clinical outcomes.Results: Baseline data did not differ between groups. The PDC+group had a higher percentage of negative fluid balance on postoperative days 1 and 2 (57% vs 33%, P = .04; 85% vs 61%, P = .01). The PDC+group had shorter time to negative fluid balance (16 vs 32 hours, P<.0001), earlier extubation (80 vs 104 hours, P = .02), improved inotrope scores (P = .04), and fewer electrolyte imbalances requiring correction (P = .03). PDC-related complications were rare.Conclusions: PDC use is safe and associated with earlier negative fluid balance and improved clinical outcomes in infants at high risk for AKI. Routine PDC use should be considered for infants undergoing cardiopulmonary bypass. Further prospective studies are essential to prove causative effects of PDC placement in this population.

Objectives: Acute kidney injury (AKI) is a frequent and serious complication in infants after cardiac surgery with cardiopulmonary bypass (CPB). Often the earliest sign is oliguria, which can lead to fluid overload, prolonged mechanical ventilation and ICU stay, abnormal electrolytes and increased mortality. We hypothesized that the use of peritoneal dialysis (PD) compared to furosemide use would mitigate these complications. Methods: This is a single-center, surgical complexity-stratified, randomized controlled trial performed within a cohort of patients younger than 6mo undergoing cardiac surgery with a preoperative plan of PD catheter placement due to risk of post-CPB kidney injury. If enrolled patients had urine output < 1mL/kg/hour for 4 hours during the first postoperative day, the patient was randomized to either a standardized regimen of furosemide or PD. If the patient demonstrated poor response to furosemide, PD could be initiated on postoperative day 2. Results: A total of 73 patients were randomized and completed the trial, including 2 patients who were randomized to furosemide and subsequently received PD. Using intention-to-treat analysis, the PD group was less likely to have fluid overload, had a lower delayed-extubation rate and fewer electrolyte replacements. There were no differences in mortality or ICU/hospital stay. No serious PD related complications were observed. PD was discontinued early in 9 patients due to pleural-peritoneal communication. Conclusions: Our study demonstrates that the use of PD in neonates with oliguria after CPB is associated with reduced morbidity but not differences in mortality or ICU/hospital stay. A multi-center study is necessary to further support these findings as well as determine association with mortality.

The heat shock response, also frequently referred to as the stress response, is an ancient, highly conserved, endogenous cellular defense mechanism characterized by the rapid upregulation of a specific class of proteins known collectively as heat shock proteins, or stress proteins. The 70 kDa family of heat shock proteins are highly inducible and have been shown to possess important immunomodulatory effects in both the intracellular and extracellular compartments. In the current prospective translational study, we measured extracellular (i.e. plasma) levels of heat shock protein 72 (Hsp72) in 49 children undergoing cardiopulmonary bypass (CPB) for either palliation or repair of congenital heart disease. There was a significant and transient increase (less than 24 h) in extracellular Hsp72 levels following CPB. Extracellular Hsp72 levels significantly correlated with levels of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8, as well as the anti-inflammatory cytokine, IL-10. In addition, plasma Hsp72 levels correlated with troponin-I levels, a marker of myocardial injury. Increased extracellular Hsp72 levels at 6 h following CPB were independently associated with increased length of stay in the cardiac intensive care unit. Importantly, the source of extracellular Hsp72 does not appear to be cardiomyocytes. However, the mechanism of release and clinical relevance of the increase in extracellular Hsp72 need to be further delineated.

Background The care of critically ill children in intensive care units (ICU) has become increasingly complex. Utilization of multidisciplinary care teams leads to reduction in mortality and length of stay, prevention of adverse events, and improvement in quality of care. However, as the number of care providers grows and patient demand increases, coordination of multidisciplinary care becomes more complicated. Objectives To improve communication during cardiac ICU multidisciplinary rounds. Methods Quality improvement methodology was utilized to evaluate implementation of a daily patient goal write-down/read-back process. The Rounds Effectiveness Assessment and Communication Tool (REACT) was developed, based on the previously validated Patient Knowledge Assessment Tool (PKAT), to evaluate comprehension of patient daily goals during multiple PDSAs (Plan, Do, Study, Act). Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. Results Baseline percent agreement for patient goals was 62%. After intervention, percent agreement improved to 85%. Family satisfaction with rounds was assessed using a 1–6 Likert scale and improved from a mean of 4.6 to 5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. Conclusions Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goals whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day. Figure 1 Rounds Effectiveness Assessment and Collaboration Tool. Figure 2 Parent Satisfaction Survey. Figure 3 REACT Results-Percent Matching Responses Per Day. Figure 4 Figure 5 Figure 6 Family Survey Results-Family survey results improved for every question, and the overall mean score improved from 4.6 to 5.7 out of 6. Table 1 Summary of PDSAs. # Plan/Do Study Act 1 Goal write-down and read-back on RN bedside sheet Unclear if beneficial during small trial, bedside staff unsure what to write down Adapt 2 Full unit trial of goal-write-down and read-back on RN bedside sheet with prompts added Only visible to the bedside RN No change in REACT scores Adapt 3 Goal write-down and read-back using 1 whiteboard Favorable response from staff regarding improved visualization, but inconsistent use Adapt 4 Goal write-down and read-back using 5 whiteboards Favorable response from staff and parents regarding improved visualization, but inconsistent use Adapt 5 Goal write-down and read-back using 5 whiteboards, extended x 3 months, with focused discussion about goals at the end of rounds Improvement in REACT scores Difficulty with categories wiping off the boards or smudging Large goals whiteboards did not fit with the permanent CCHMC family communication boards Adapt 6 Goal write-down and read-back on 1 legal size laminated sheet Smaller sheets are more mobile, no issues with categories wiping off Compatible with CCHMC family communication board. Concern was voiced regarding potentially reduced visibility of goals Adapt 7 Goal write-down and read-back using 3 legal size laminated sheets REACT scores maintained ADOPT

This review aims to clarify pathophysiologic mechanisms underlying interactions between the pulmonary and cardiovascular systems. Therapeutic interventions primarily targeting respiratory function during mechanical ventilation of critically ill cardiac patients may have an inevitable secondary effect on the heart and vice versa. A thorough understanding of these complex interactions is a prerequisite for clinical care and may lead to novel therapeutic strategies and improved outcomes.

Purpose of review The focus of postoperative care in the pediatric patient with congenital heart disease has become a reduction in length of stay and morbidity. This review will discuss strategies to achieve this goal and recent studies to support current practices. Recent findings Most agree that prolongation of the length of stay following a cardiac surgery contributes to morbidity. Postoperative feeding difficulty, hyperglycemia, acute kidney injury, fluid overload, and prolonged intubation contribute significantly to length of stay. Summary Postoperative care of the neonate and child following a cardiac surgery remains challenging with limited data to drive our practices. Patients remain at risk for significant morbidity, and future studies should focus on recognizing predictors of morbidity, prevention, and treatment.

Purpose Acute kidney injury (AKI) after cardiopulmonary bypass surgery to correct congenital heart disease is common. We prevent fluid overload and further cardiac compromise in oliguric infants with continuous peritoneal dialysis (CPD). The effect of CPD on kidney recovery is unknown, thus indications to discontinue CPD are unclear. We aimed to determine if CPD affects kidney recovery, measured by urine output and novel urinary AKI biomarker concentrations. Methods Twenty infants <90 days old with congenital heart disease who underwent bypass surgery and were post-operatively treated with CPD were randomized at the time of clinical readiness for CPD discontinuation to 1) discontinue CPD (control) or 2) continue 24 h more CPD (experimental). Urine output (ml/kg per h), total output (ml/kg per h) and urinary neutrophil gelatinase-associated lipocalin, interleukin-18, liver-type fatty acid binding protein, and kidney injury molecule-1 were assessed post-surgery until CPD catheter removal. Results 24 hours preceding randomization, there were no differences in mean urine output or total output; 24 hours post-randomization, the control group had higher mean urine output (4.2 ± 2.6 ml/kg per h vs. 2.8 ± 2.0 ml/kg per h, p = 0.02) but lower total output (6.3 ± 2.1 ml/kg per h vs. 4.7 ± 2.7 ml/kg per h, p = 0.01). Median biomarker concentrations did not differ significantly between groups at any time point. Conclusions Our results suggest renal replacement therapy does not change the time course of kidney function recovery.