Background The aim of this study was to compare the predictive accuracy of acute kidney injury (AKI) after cardiac surgery using cardiopulmonary bypass for the largest area under the curve (AUC) below the oxygen delivery (DO 2 ) threshold and the cumulative AUC below the DO 2 threshold. Methods and Results From March 2017 to October 2019, 202 patients who had undergone cardiac surgery with cardiopulmonary bypass were enrolled. The perfusion parameters were recorded every 20 seconds, and the DO 2 (10×pump flow index [L/min per m 2 ]×[hemoglobin (g/dL)×1.36×arterial oxygen saturation (%)+partial pressure of arterial oxygen (mm Hg)×0.003]) threshold of 300 mL/min per m 2 was considered to define sufficient DO 2 . The nadir DO 2 , the cumulative AUC below the , and the largest AUC below the were used to predict the incidence of AKI. Postoperative AKI was observed in 12.4% of patients (25/202). By multivariable analysis, the largest AUC below the ≥880 (odds ratio [OR], 4.9; 95% CI, 1.2–21.5 [ P =0.022]), preoperative hemoglobin concentration ≤11.6 g/dL (OR, 7.6; 95% CI, 2.0–32.3 [ P =0.004]), and red blood cell transfusions during cardiopulmonary bypass ≥2 U (OR, 3.3; 95% CI, 1.0–11.1 [ P =0.041]) were detected as independent risk factors for AKI. Receiver operating curve analysis revealed that the largest AUC below the was more accurate to predict postoperative AKI compared with the nadir DO 2 and the cumulative AUC below the (differences between areas, 0.0691 [ P =0.006] and 0.0395 [ P =0.001]). Conclusions These data suggest that a high AUC below the is an important independent risk factor for AKI after cardiopulmonary bypass, which could be considered for risk prediction models of AKI.
The conventional formula is unable to predict the actual haemodilution rate accurately. Our new formula with a combination of the ideal BW and adjustment for age was shown to be useful for the accurate prediction of the haemodilution rate during CPB.
The early detection of acute myocardial infarction, which is caused by lifestyle-related risk factors, is essential because it can lead to chronic heart failure or sudden death. Echocardiography, among the most common methods used to detect acute myocardial infarction, is a noninvasive modality for the early diagnosis and assessment of abnormal wall motion. However, depending on disease range and severity, abnormal wall motion may be difficult to distinguish from normal myocardium. As abnormal wall motion can lead to fatal complications, high accuracy is required in its detection over time on echocardiography. This study aimed to develop an automatic detection method for acute myocardial infarction using convolutional neural networks (CNNs) and long short-term memory (LSTM) in echocardiography. The short-axis view (papillary muscle level) of one cardiac cycle and left ventricular long-axis view were input into VGG16, a CNN model, for feature extraction. Thereafter, LSTM was used to classify the cases as normal myocardium or acute myocardial infarction. The overall classification accuracy reached 85.1% for the left ventricular long-axis view and 83.2% for the short-axis view (papillary muscle level). These results suggest the usefulness of the proposed method for the detection of myocardial infarction using echocardiography.
Acute Kidney Injury Network を用いた 10) 。 結果:AKI は 59 例(15.9%)に認めた。AKI 群の方が CRRT 導入率は有意に高く、ICU 滞在期間、術後入院日数 においても有意に長かった。多変量解析の結果、体重≧66.1kg、術前推算糸球体濾過量(estimated glomerular filtration rate:eGFR)<56.9mL/min/1.73m 2 、術中濃厚赤血球(red blood cells:RBC)輸血≧6 IU、CPB 中最低酸素 供給量(oxygen delivery:DO2)<259mL/min/m 2 、CPB 中尿量<2.8mL/kg/h が CPB 後 AKI 発症と有意に関連 していた。 結語:手術中は極力 RBC 輸血を避け、CPB 中最低 DO2 を 259mL/min/m 2 以上に維持し、十分な尿量(2.8mL/h 以 上)が得られているかをモニタリングすることで AKI 発症を軽減できることが示唆された。 索引用語:急性腎障害(AKI) 、酸素供給量(DO2) 、尿量 Examination of acute kidney injury after cardiac surgery with cardiopulmonary bypass Tomoya Oshita 1) ,Kazuyuki Nagata 1) ,Kosuke Nakajima 1) ,Ryosuke Muraki 1) ,Masahisa Arimichi 1) ,Arudo Hiraoka 2) , Taichi Sakaguchi 2) Abstract Background:Acute kidney injury (AKI) is a severe complication that can occur after open heart surgery and known to exacerbate prognosis. However, patient management during a cardiopulmonary bypass (CPB) procedure to prevent AKI has not been established. Here, we retrospectively investigated AKI in patients who underwent cardiac surgery with CPB. Patients and Methods:We conducted a retrospective analysis of 371 patients who underwent open heart surgery with CPB from 2012 to 2015 at the Sakakibara Heart Institute of Okayama, Japan. For cases with a CPB time of 120 minutes or longer and a minimum bladder temperature of 32˚C or more, AKI was defined according to the Acute Kidney Injury Network (AKIN) classification criteria. 10) Results:AKI developed in 59 patients (15.9%). In the AKI group, the rate of introduction of continuous renal replacement therapy was significantly higher, and they also had significantly longer ICU and postoperative hospital stay durations. Multivariable analysis showed that body weight greater than 66.1kg, preoperative estimated glomerular filtration rate lower than 56.9mL/min/1.73m 2 , administration of red blood cells greater than 6 IU, lowest oxygen delivery (DO2) during CPB less than 259mL/min/m 2 , and amount of urine output during CPB less than 2.8mL/kg/h were significantly associated with AKI development after CPB. Conclusion:Our results indicate that DO2 greater than 259mL/min/m 2 during CPB and monitoring urine output amount (>2.8mL/kg/h) during CPB are independent factors related to a decrease in risk of AKI in cardiac surgery patients. Key words:acute kidney injury (AKI) , oxygen delivery (DO2) , urine output Jpn J Extra-Corporeal Technology 44 (4) :375 − 380, 2017 1)心臓病センター榊原病院 臨床工学科 大下智也(Tomoya Oshita) 〒 700-0804 岡山市北区中井町 2-5-1
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