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.
We developed a new circulation-assist device that can generate pulsatile assist flow synchronized with the patient's diastolic phase. The device is composed of a drainage tube, a centrifugal pump, an oxygenator, and a sending tube. A portable magnetic valve device composed of a pulse generator and a tamper, which produces intermittent mechanical compression, is attached to the pillow of the sending tube. Preliminary animal experiments were conducted. No changes in the animals' hemodynamics or any device problems were observed during a preliminary 48-h test run. Significant diastolic augmentation was confirmed. This new device may be useful in treating patients with severe heart failure and could be more useful than using percutaneous cardiopulmonary support (PCPS) alone.
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
Objective:During cardiopulmonary bypass(CPB)on Minimally Invasive Cardiac Surgery(MICS) ,there are few reports that gave Mannitol of CPB continuously, and the clinical response is not clear. The aim of this study is to inspect influied balance in the perioperative period by giving Mannitol in CPB continuously and influence on oxygenicity. Method:We collected 84 CPB cases which went by MICS from November, 2012 to December, 2014. The detail of it, 39 cases after September, 2013 were the things which we gave Mannitol to continuously(C group) ,and, 45 cases before September, 2013 did not use Mannitol continuously(nonC group) . Results:The urine until 12 hours after an operation from all over the operation and balance growth rate(IBGR)during CPB were no significant. However, the IBGR significantly recognized improvement after during the operation and an operation in C group over 12 hours. After distributing two groups according to renal function more, IBGR rose in RF group, but tended IBGR was improved in C group. Also A-aDO2 and P/F ratio were no significant between C group and the nonC group, but P/F ratio significantly relates to IBGR. Conclusions:Efficacy of continuous infusion of Mannitol during extracorporeal circulation is control IBGR, and it may also prevent postoperative respiratory complications in MICS. Key words:mannitol,minimally invasive cardiac surgery(MICS) ,influied barance,peri operative
The hemolysis avoidance is important to manage percutaneous cardio pulmonary support Kosuke Nakajima 1) ,Kazuyuki Nagata 1) ,Tomoya Oshita 1) ,Ryosuke Muraki 1) ,Masahisa Arimichi 1) ,Arudo Hiraoka 2) , Akihiro Hayashida 3) ,Hidenori Yoshitaka 2) ,Taichi Sakaguchi 2
Postoperative cognitive dysfunction following cardiac surgeryKazuyuki Nagata 1) ,Kosuke Nakajima 1) ,Arudo Hiraoka 3) ,Masahisa Arimichi 1) ,Tomoya Oshita 1) ,Ryosuke Muraki 1) , Yoshitaka Naito 2) ,Manami Himeno 2) ,Taichi Sakaguchi 3) Abstract [Background] Various causes of postoperative cognitive dysfunction (POCD) following cardiac surgery have been speculated, including a previous report that found use of a heart-lung machine to be a causative factor. [Methods] We investigated 160 consecutive patients who underwent a heart valve operation with a cardiopulmonary bypass, and received 4 different types of pre-and postoperative recognition function tests. Those who showed a greater than 20% reduction in postoperative test values or experienced difficulty with the assessments following surgery were judged to be POCD. Factors related to POCD occurrence were then evaluated using multivariate analysis. [Results] POCD occurred in 49 cases (30.6%) . Comparisons between the onset and non-onset groups revealed that patients with onset were significantly older, while many of those had a medical history of cognitive impairment and blood symptoms, as well as higher HbA1c values. The onset group also had a significantly shorter rewarming time during cardiopulmonary bypass, and significantly lower perfusion index (PI) , hemoglobin, and oxygen delivery (DO2i) values during re-[原稿受領日:2019 年 1 月 15 日 採択日:2019 年 3 月 1 日] 永田和之 1) ・中島康佑 1) ・平岡有努 3) ・有道真久 1) ・大下智也 1) 村木亮介 1) ・内藤善隆 2) ・姫野麻菜美 2) ・坂口太一 3) 人工心肺を用いた心臓手術における術後高次脳機能障害の検討 1)心臓病センター榊原病院 臨床工学科 永田和之
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