Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial |
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| Affiliation: | 1. Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan;2. Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan;1. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn;2. Department of Heart Failure and Heart Transplantation, Centro Médico Nacional Siglo XXI, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico;3. Heart Failure and Heart Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain;4. Department of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico;2. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI;3. Banyan Biomarkers, Inc., Alachua, FL;4. Hugo Moser Research Institute at Kennedy Krieger and Departments of Neurology and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore MD;1. Cardiovascular Surgery Department, Virgen de la Macarena University Hospital, Sevilla, Spain;2. Cardiovascular Surgery Department, La Fe University Hospital, Valencia, Spain;3. Cardiovascular Surgery Department, Germans Trias I Pujol Hospital, Badalona, Spain;4. Cardiovascular Surgery Department, Reina Sofia University Hospital, Cordoba, Spain;5. Cardiovascular Surgery Department, Clinic University Hospital, Santiago de Compostela, Spain;6. Cardiovascular Surgery Department, Clinic University Hospital, Valladolid, Spain;1. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md;2. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md;4. Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Md;5. Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Md;6. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;7. Adventist Healthcare White Oak Medical Center, Silver Spring, Md;1. Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY;2. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY;3. Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY |
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| Abstract: | ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m2 through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m2, the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury. |
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| Keywords: | cardiac surgery cardiopulmonary bypass management goal-directed perfusion hemodilution optimal perfusion AKI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" acute kidney injury AUC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" area under the curve BSA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" body surface area CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" confidence interval CPB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" cardiopulmonary bypass oxygen delivery oxygen delivery index eGFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" estimated glomerular filtration rate Hb" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" hemoglobin Hct" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" hematocrit ICU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" intensive care unit MAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" mean arterial pressure RBC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" red blood cell RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial |
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