End-of-Procedure Volume Responsiveness Defined by the Passive Leg Raise Test Is Not Associated With Acute Kidney Injury After Cardiopulmonary Bypass

Zaky, Ahmed; Younan, Duraid; Meers, Bradley; Davies, James E.; Pereira, Sara J.; Melvin, Ryan L.; Kidd, Brent; Morgan, Charity; Tolwani, Ashita J.; Pittet, Jean François

doi:10.1053/j.jvca.2020.11.022

Cited by 3 publications

(7 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To remedy this gap in the less studied delayed forms of kidney decline post CPB 4 – 6 , we report our preliminary data on kidney function at the first postoperative visit in a cohort of our patients who have undergone CPB 7 . Our secondary objective is to assess predictors of kidney function decline at first postoperative visit.…”

Section: Introductionmentioning

confidence: 99%

A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass

Zaky,

Younan,

Meers

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

There is no current consensus on the follow up of kidney function in patients undergoing cardiopulmonary bypass (CPB). The main objectives of this pilot study is to collect preliminary data on kidney function decline encountered on the first postoperative visit of patients who have had CPB and to identify predictors of kidney function decline post hospital discharge. Design: Retrospective chart review. Adult patients undergoing open heart procedures utilizing CPB. Patient demographics, type of procedure, pre-, intra-, and postoperative clinical, hemodynamic echocardiographic, and laboratory data were abstracted from electronic medical records. Acute kidney disease (AKD), and chronic kidney disease (CKD) were diagnosed based on standardized criteria. Interval change in medications, hospital admissions, and exposure to contrast, from hospital discharge till first postoperative visit were collected. AKD, and CKD as defined by standardized criteria on first postoperative visit. 83 patients were available for analysis. AKD occurred in 27 (54%) of 50 patients and CKD developed in 12 (42%) out of 28 patients. Older age was associated with the development of both AKD and CKD. Reduction in right ventricular cardiac output at baseline was associated with AKD (OR: 0.5, 95% CI: 0.3, 0.79, P = 0.01). Prolongation of transmitral early diastolic filling wave deceleration time was associated with CKD (OR: 1.02, 95% CI: 1.01, 1.05, P = 0.03). In-hospital acute kidney injury (AKI) was a predictor of neither AKD nor CKD. AKD and CKD occur after CPB and may not be predicted by in-hospital AKI. Older age, right ventricular dysfunction and diastolic dysfunction are important disease predictors. An adequately powered longitudinal study is underway to study more sensitive predictors of delayed forms of kidney decline after CPB.

show abstract

Section: Introductionmentioning

confidence: 99%

A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass

Zaky,

Younan,

Meers

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thus, ventilator-induced indicators are less reliable in this setting and the classical PLR manoeuvre is hardly applicable during open-chest surgery [9,[13][14][15][16][17], although some studies altering the positioning of the patient have been performed at the end of cardiac surgery after chest closure [18,19].…”

Section: Introductionmentioning

confidence: 99%

Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery

Berg

Nielsen

Abromaitiene

et al. 2021

J Clin Monit Comput

View full text Add to dashboard Cite

Prediction of fluid responsiveness is essential in perioperative goal directed therapy, but dynamic tests of fluid responsiveness are not applicable during open-chest surgery. We hypothesised that two methods could predict fluid responsiveness during cardiac surgery based on their ability to alter preload and thereby induce changes in arterial blood pressure characteristics:(1) the change caused by extrasystolic beats and (2) the change caused by a fast infusion of 50 ml crystalloid (micro-fluid challenge). Arterial blood pressure and electrocardiogram waveforms were collected during surgical preparation of the left internal mammary artery in patients undergoing coronary artery bypass surgery. Patients received a fluid challenge (5 ml/ kg ideal body weight). The first 50 ml were infused in 10 s and comprised the micro-fluid challenge. Predictor variables were defined as post-ectopic beat changes (compared with sinus beats preceding ectopy) in arterial blood pressure characteristics, such as pulse pressure and systolic pressure, or micro-fluid challenge induced changes in the same blood pressure characteristics. Patients were considered fluid responsive if stroke volume index increased by 15% or more after the full fluid challenge. Diagnostic accuracy was calculated by the area under the receiver operating characteristics curve (AUC). Fifty-six patients were included for statistical analysis. Thirty-one had extrasystoles. The maximal AUC was found for the extrasystolic change in pulse pressure and was 0.70 (CI [0.35 to 1.00]). The micro-fluid challenge method generally produced lower AUC point estimates. Extrasystoles did not predict fluid responsiveness with convincing accuracy in patients undergoing cardiac surgery and changes in arterial waveform indices following a micro-fluid challenge could not predict fluid responsiveness. Given a low number of fluid responders and inherently reduced statistical power, our data does not support firm conclusions about the utility of the extrasystolic method. Clinical Trial Registration Unique identifier: NCT02903316. https:// clini caltr ials. gov/ ct2/ show/ NCT02 903316? cond= NCT02 90331 6& rank=1.

show abstract

“…In this issue of the Journal of Cardiothoracic Anesthesia, Zaky Bypass". 1 In this study the investigators tested for volume responsiveness by performing passive leg raising (PLR) on 129 cardiac surgical patients at the conclusion of the procedure, prior to transport to the intensive care unit. Their hypothesis was that volume responsiveness at the conclusion of cardiac surgery is predictive of perioperative Acute Kidney Injury (AKI).…”

mentioning

confidence: 99%

“…Zaky, et al point out that assessment of the renal microcirculation and sensitive biomarkers will aid in understanding perturbations in renal perfusion in the future. 1 The mere fact that a patient is potentially volume responsive does not mean they need or should receive fluid.…”

mentioning

confidence: 99%

“…9 As Zaky, et al point out, excess fluid administration resulting from GDFT implementation can increase the incidence of AKI. 1,10 This author believes the adage "Give enough fluid, but not a drop more" applies, since fluid overload can lead to heart failure in the cardiac surgical population, as well as AKI, increased lung water, and edema affecting the airway. Certainly, then, providing fluid boluses simply because volume responsiveness is present is ill advised, particularly in cardiac surgical patients where cardiac and other organ failures are such high risks.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Volume Responsiveness: What It Does Not Tell Us

Manecke

2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

End-of-Procedure Volume Responsiveness Defined by the Passive Leg Raise Test Is Not Associated With Acute Kidney Injury After Cardiopulmonary Bypass

Cited by 3 publications

References 33 publications

A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass

A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass

Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery

Volume Responsiveness: What It Does Not Tell Us

Contact Info

Product

Resources

About