Examination of acute kidney injury after cardiac surgery with cardiopulmonary bypass

Abstract

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

Tricuspid Valve Infective Endocarditis

“…Adding hemofiltration, leukocyte-depleting filters and/ or cytokine filters (CytoSorb®) to the pump circuit is particularly appealing in this patient population because of their pro-inflammatory state and hypervolemic status. However, evidence to support their use is still lacking [60,61].…”