Effect of Remote Ischemic Preconditioning on Patients Undergoing Elective Major Vascular Surgery: A Systematic Review and Meta-analysis

Ouyang, Huan; Zhou, Meng; Xu, Jiahui; Fang, Cuifu; Zhong, Zhiwei; Zhou, Yu; Xu, Jiasheng; Zhou, Wei

doi:10.1016/j.avsg.2019.05.035

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…For a considerable period, it has been recognized that transient hypoxic or ischemic preconditioning, remote ischemic preconditioning, and chronic hypoxia exposure offer protection to the heart against acute I-R injury in animals. Recent clinical trials have shown the limited improvement effect of transient limb remote ischemic preconditioning on clinical outcomes of surgical patients (3)(4)(5)(6)(7). Nonetheless, there are still doubts as to whether other hypoxic or ischemic methods can produce clinically significant myocardial protective effects.…”

Section: High-altitude Adaptation and Myocardial Protectionmentioning

confidence: 99%

“…Clinical practice does not allow for the application of many short-term pretreatment techniques, such as hypoxic or myocardial ischemic preconditioning, which significantly reduce myocardial I-R injury in animal experiments (2). Remote ischemic preconditioning has also been confirmed to be cardioprotective in animal studies, nonetheless, the results of several clinical studies have generated controversy (3)(4)(5)(6)(7). In a multicenter randomized clinical trial involving adult patients underwent cardiac surgery, there was no significant difference in the incidences of primary end point between the remote ischemic preconditioning group (14.3%) and the control group (14.6%) (8).…”

Section: Introductionmentioning

confidence: 99%

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Cardioprotective effects of high-altitude adaptation in cardiac surgical patients: a retrospective cohort study with propensity score matching

Lei,

Liu,

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe cardioprotective effect of remote ischemia preconditioning in clinical studies is inconsistent with experimental results. Adaptation to high-altitude hypoxia has been reported to be cardioprotective in animal experiments. However, the clinical significance of the cardioprotective effect of high-altitude adaptation has not been demonstrated.MethodsA retrospective cohort study with propensity score matching was designed to compare the outcomes of cardiac surgery between highlanders and lowlanders in a tertiary teaching hospital. The data of adult cardiac surgical patients from January 2013 to December 2022, were collected for analysis. Patients with cardiopulmonary bypass and cardioplegia were divided into a low-altitude group (<1,500 m) and a high-altitude group (≥1,500 m) based on the altitude of their place of residence.ResultsOf 3,020 patients, the majority (87.5%) permanently lived in low-altitude regions [495 (435, 688) m], and there were 379 patients (12.5%) in the high-altitude group [2,552 (1,862, 3,478) m]. The 377 highlander patients were matched with lowlander patients at a ratio of 1:1. The high-altitude group exhibited a 44.5% reduction in the incidence of major adverse cardiovascular events (MACEs) compared with the low-altitude group (6.6% vs. 11.9%, P = 0.017). The patients in the moderate high-altitude subgroup (2,500–3,500 m) had the lowest incidence (5.6%) of MACEs among the subgroups. The level of creatinine kinase muscle-brain isoenzymes on the first postoperative morning was lower in the high-altitude group than in the low-altitude group (66.5 [47.9, 89.0] U/L vs. 69.5 [49.3, 96.8] U/L, P = 0.003).ConclusionsHigh-altitude adaptation exhibits clinically significant cardioprotection in cardiac surgical patients.

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Section: High-altitude Adaptation and Myocardial Protectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardioprotective effects of high-altitude adaptation in cardiac surgical patients: a retrospective cohort study with propensity score matching

Lei,

Liu,

et al. 2024

Front. Cardiovasc. Med.

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“…The renal protective effect of RIPC has been extensively studied in the various types of procedures, including cardiac surgery or procedure [23], major vascular surgery [24], and percutaneous coronary intervention (PCI) [25], while the effect for renal protection is inconclusive. Partial nephrectomy is a standard treatment for localized small kidney tumors [7].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

Chung

Hur

Cho

et al. 2021

JCM

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Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72–1.03) in the RIPC group vs. 0.92 mg/dL (0.71–1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes.

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“…A 2019 meta-analysis concluded that RIPC did not reduce the incidence of AKI following cardiac surgery with CPB. 66 Another systematic review and meta-analysis in 2020 showed no benefit with the use of frusemide in reducing the postoperative AKI. 67 …”

Section: G Uidelines —A Cute K ...mentioning

confidence: 99%

ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

Chaudhry¹,

Chacko²,

Govil³

et al. 2022

Indian Journal of Critical Care Medicine

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Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al . ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13–S42.

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Effect of Remote Ischemic Preconditioning on Patients Undergoing Elective Major Vascular Surgery: A Systematic Review and Meta-analysis

Cited by 7 publications

References 29 publications

Cardioprotective effects of high-altitude adaptation in cardiac surgical patients: a retrospective cohort study with propensity score matching

Cardioprotective effects of high-altitude adaptation in cardiac surgical patients: a retrospective cohort study with propensity score matching

The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

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