Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting

Rettig, Thijs C D; Peelen, Linda M.; Geuzebroek, Guillaume S.C.; Klei, Wilton A. van; Boer, Christa; Veer, Jan Willem van der; Hofland, Jan; Garde, E.M.W. van de; Noordzij, Peter G.

doi:10.1053/j.jvca.2016.07.040

Cited by 25 publications

(10 citation statements)

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“…Cumulative evidence showed an association between intraoperative hypotension and postoperative morbidity in patients undergoing abdominal [25,26], vascular [27] and cardiac surgeries [28]. Intraoperative hypotension was found to be related to the development of myocardial injury [12,13,26,27,29], AKI [11,12,29,30], and even death [16,17,31] after surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hypotension is associated with increased postoperative complications in patients undergoing surgery for pheochromocytoma-paraganglioma: a retrospective cohort study

Kong

et al. 2020

BMC Anesthesiol

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Background: Dramatic hemodynamic fluctuation occurs frequently during surgery for pheochromocytoma or paraganglioma. However, the criteria of intraoperative hemodynamic instability vary widely, and most of them were defined arbitrarily but not according to patients' prognosis. The objective was to analyze the relationship between different thresholds and durations of intraoperative hyper−/hypotension and the risk of postoperative complications in patients undergoing surgery for pheochromocytoma or paraganglioma. Methods: This was a retrospective single-center cohort study performed in a tertiary care hospital from January 1, 2005 to December 31, 2017. Three hundred twenty-seven patients who underwent surgery for pheochromocytoma or paraganglioma, of which the diagnoses were confirmed by postoperative pathologic examination, were enrolled. Those who were less than 18 years, underwent surgery involving non-tumor organs, or had incomplete data were excluded. The primary endpoint was a composite of the occurrence of AKI or other complications during hospital stay after surgery. Multivariate Logistic regression models were used to analyze the association between different thresholds and durations of intraoperative hyper−/hypotension and the development of postoperative complications. Results: Forty three (13.1%) patients developed complications during hospital stay after surgery. After adjusting for confounding factors, intraoperative hypotension, defined as systolic blood pressure (SBP) of ≤95 mmHg for ≥20 min (OR 3.211; 99% CI 1.081-9.536; P = 0.006), SBP of ≤90 mmHg for ≥20 min (OR 3.680;; P = 0.006), SBP of ≤85 mmHg for ≥10 min (OR 3.975; 98.3% CI 1.321-11.961; P = 0.003), and SBP of ≤80 mmHg for ≥1 min (OR 3.465; 95% CI 1.484-8.093; P = 0.004), were associated with an increased risk of postoperative complications. On the other hand, intraoperative hypertension was not significantly associated with the development of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Intraoperative hypotension is associated with increased postoperative complications in patients undergoing surgery for pheochromocytoma-paraganglioma: a retrospective cohort study

Kong

et al. 2020

BMC Anesthesiol

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“…It is possible, therefore, that hypotension outside the CPB phase is an important risk factor that needs to be taken into consideration, and more research is needed regarding the effects of hypotension during and outside CPB. 30,31 Advanced hemodynamic monitoring and protocolized treatment strategies in the cardiac surgical setting can identify and treat hemodynamic changes earlier than in noncardiac surgery with noninvasive monitoring. In this study, we did not observe a statistically significant association between vasopressor-inotrope dose or total dose of milrinone and the composite outcome.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Hypotension and Acute Kidney Injury, Stroke, and Mortality during and outside Cardiopulmonary Bypass: A Retrospective Observational Cohort Study

et al. 2022

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Background In cardiac surgery, the association between hypotension during specific intraoperative phases or vasopressor-inotropes with adverse outcomes remains unclear. We hypothesized that intraoperative hypotension duration throughout the surgery or when separated into hypotension during and outside CPB may be associated with postoperative major adverse events. Methods In this retrospective observational cohort study, we included adults who had cardiac surgery between 2008 and 2016 in a tertiary hospital. Intraoperative hypotension was defined as mean arterial pressure (MAP) <65mmHg. The total duration of hypotension was divided into three categories based on the fraction of overall hypotension duration which occurred during CPB (>80%, 80-60%, <60%). The primary outcome was a composite of stroke, acute kidney injury (AKI) or mortality during the index hospitalization. The association with the composite outcome was evaluated for duration of hypotension during the entire surgery, outside CPB, during CPB and fraction of hypotension during CPB, adjusting for vasopressor-inotrope dose, milrinone dose, patient and surgical factors. Results The composite outcome occurred in 256 (5.1%) of 4984 included patient records; 66(1.3%) patients suffered stroke, 125(2.5%) AKI, and 109(2.2%) mortality. The primary outcome was associated with total duration of hypotension [adjusted odds ratio 1.05(95% CI 1.02, 1.08; P=0.032)], hypotension outside CPB [adjusted odds ratio 1.06(95% CI 1.03, 1.10; P=0.001)] per 10 min exposure to MAP <65mmHg, and fraction of hypotension duration during CPB <60% (reference >80%) [adjusted odds ratio 1.67(95% CI 1.10, 2.60; P=0.019)], but not with each 10-minute period hypotension during CPB [adjusted odds ratio 1.04(95% CI 0.99, 1.09, P=0.118)], fraction of hypotension during CPB of 60-80% [adjusted OR 1.45; 95% CI (0.97, 2.23): P = 0.082], or total vasopressor-inotrope dose [adjusted odds ratio 1.00(95% CI 1.00, 1.00, P=0.247)]. Conclusion We confirm previous single-center findings that intraoperative hypotension throughout cardiac surgery is associated with an increased risk of AKI, mortality, or stroke.

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“…Complex, time-varying biologic signals are often best characterized by their central tendency, explaining why we 2,3,[12][13][14] and others 4,6,[15][16][17][18][19][20][21][22][23] used the mean to evaluate relationships between blood pressure and outcomes such as myocardial and kidney injury. While using the mean is a reasonable mathematical approach, blood pressure presents a special challenge in being characterized by systolic, mean, and diastolic components, along with pulse pressure which is a measure of signal excursion.…”

Section: Editor's Perspectivementioning

confidence: 99%

Associations of Intraoperative Radial Arterial Systolic, Diastolic, Mean, and Pulse Pressures with Myocardial and Acute Kidney Injury after Noncardiac Surgery

et al. 2020

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Arterial pressure is a complex signal that can be characterized by systolic, mean, and diastolic components, along with pulse pressure (difference between systolic and diastolic pressures). The authors separately evaluated the strength of associations among intraoperative pressure components with myocardial and kidney injury after noncardiac surgery. Methods The authors included 23,140 noncardiac surgery patients at Cleveland Clinic who had blood pressure recorded at 1-min intervals from radial arterial catheters. The authors used univariable smoothing and multivariable logistic regression to estimate probabilities of each outcome as function of patients’ lowest pressure for a cumulative 5 min for each component, comparing discriminative ability using C-statistics. The authors further assessed the association between outcomes and both area and minutes under derived thresholds corresponding to the beginning of increased risk for the average patient. Results Out of 23,140 patients analyzed, myocardial injury occurred in 6.1% and acute kidney injury in 8.2%. Based on the lowest patient blood pressure experienced for greater than or equal to 5 min, estimated thresholds below which the odds of myocardial or kidney injury progressively increased (slope P < 0.001) were 90 mmHg for systolic, 65 mmHg for mean, 50 mmHg for diastolic, and 35 mmHg for pulse pressure. Weak discriminative ability was noted between the pressure components, with univariable C-statistics ranging from 0.55 to 0.59. Area under the curve in the highest (deepest) quartile of exposure below the respective thresholds had significantly higher odds of myocardial injury after noncardiac surgery and acute kidney injury compared to no exposure for systolic, mean, and pulse pressure (all P < 0.001), but not diastolic, after adjusting for confounding. Conclusions Systolic, mean, and pulse pressure hypotension were comparable in their strength of association with myocardial and renal injury. In contrast, the relationship with diastolic pressure was poor. Baseline factors were much more strongly associated with myocardial and renal injury than intraoperative blood pressure, but pressure differs in being modifiable.

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Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting

Cited by 25 publications

References 23 publications

Intraoperative hypotension is associated with increased postoperative complications in patients undergoing surgery for pheochromocytoma-paraganglioma: a retrospective cohort study

Intraoperative hypotension is associated with increased postoperative complications in patients undergoing surgery for pheochromocytoma-paraganglioma: a retrospective cohort study

Intraoperative Hypotension and Acute Kidney Injury, Stroke, and Mortality during and outside Cardiopulmonary Bypass: A Retrospective Observational Cohort Study

Associations of Intraoperative Radial Arterial Systolic, Diastolic, Mean, and Pulse Pressures with Myocardial and Acute Kidney Injury after Noncardiac Surgery

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