Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: A quality initiative pre–post analysis

Johnston, Lily E.; Thiele, Robert H.; Hawkins, Robert B.; Downs, Emily A.; Jaeger, J. Michael; Brooks, Charles H.; Ghanta, Ravi K.; Ailawadi, Gorav; Krön, Irving L.; Isbell, James M.

doi:10.1016/j.jtcvs.2019.03.135

Cited by 26 publications

(15 citation statements)

References 19 publications

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“…20 Goal-directed volume resuscitation in noncardiac surgery has been shown to reduce postoperative AKI, and early evidence supports a similar strategy in adult cardiac surgery patients. 21,22 These studies focused on the postoperative period in which this study was the first investigation to identify the importance of fluid management during cardiac surgery with CPB to potentially reduce the early occurrence of renal stress.…”

Section: Discussionmentioning

confidence: 99%

Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Manning

Linder³

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 99%

Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Manning

Linder³

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Given the morbidity and mortality associated with AKI post cardiac surgery [4,5,13], investigative research has ranged from identifying at-risk patients [14,15] to using urinary and plasma biomarkers [7] and goal-directed therapies [16].…”

Section: Discussionmentioning

confidence: 99%

Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

Luckraz

Giri

Wrigley³

et al. 2020

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits. Clinical trial registration number: NCT02974946

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“…Vasopressor and inotropic therapy were initiated if the patient needed additional hemodynamic support. 28,29 The effects of vasoactive medications on the functional microcirculation are incompletely understood but theoretically will directly affect capillary blood flow via precapillary sphincter augmentation. A majority of subjects in this study received phenylephrine to reverse postoperative vasoplegia, and 4 patients received vasopressin in addition.…”

Section: -26mentioning

confidence: 99%

Severe Impairment of Microcirculatory Perfused Vessel Density Is Associated With Postoperative Lactate and Acute Organ Injury After Cardiac Surgery

Greenwood

Jang

Hallisey

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: A quality initiative pre–post analysis

Cited by 26 publications

References 19 publications

Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

Severe Impairment of Microcirculatory Perfused Vessel Density Is Associated With Postoperative Lactate and Acute Organ Injury After Cardiac Surgery

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