Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery

Carrasco-Serrano, Elena; Jorge-Monjas, Pablo; Muñoz-Moreno, María Fé; Sánchez, Esther Gómez; Priede-Vimbela, Juan Manuel; Bardají-Carrillo, Miguel; Cubero-Gallego, Héctor; Tamayo, Eduardo; Ortega-Loubón, Christian

doi:10.3390/jcm11113046

Cited by 6 publications

(3 citation statements)

References 39 publications

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“…Oxygen delivery, avoidance of hypoperfusion, and cardiac output augmentation continue to be the backbone of CSA-AKI prevention based the on current understanding of pathophysiology [ 76 , 79 ]. For example, goal-directed perfusion with oxygen delivery index >270–300 mL/min/m 2 has recently been shown to improve CSA-AKI, but not in patients with high risk for postoperative AKI [ 79 , 80 , 81 , 82 , 83 , 84 ]. Other maneuvers have also been investigated.…”

Section: Part 2 – Selected Gaps In Knowledge and Future Direction Of ...mentioning

confidence: 99%

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action

et al. 2022

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Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate in the coming decades. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry. This two-part review concentrates on CT-CCM as its own subspeciality of critical care and cardiothoracic surgery and provides aspirational goals for its practitioners and scientists. In part one, a list of guiding principles and a call-to-action agenda geared towards growth and promotion of CT-CCM are offered. In part two, an evaluation of selected scientific data is performed, identifying gaps in CT-CCM knowledge, and recommending direction to future scientific endeavors.

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Section: Part 2 – Selected Gaps In Knowledge and Future Direction Of ...mentioning

confidence: 99%

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action

et al. 2022

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“…Nadir indexed oxygen delivery (DO 2 i) during CPB is identified as a potentially modifiable risk factor for postoperative AKI (4). Previous observational studies have determined the critical threshold of DO 2 i to avoid postoperative AKI, in the range of 225-300 mL/min/m 2 during CPB (5)(6)(7)(8). Goal-directed perfusion (GDP) aimed to maintain DO 2 i above a critical threshold during CPB, reducing the incidence of AKI by approximately 50% (9).…”

Section: Introductionmentioning

confidence: 99%

Nadir oxygen delivery is associated with postoperative acute kidney injury in low-weight infants undergoing cardiopulmonary bypass

Gao

Jin

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAcute kidney injury (AKI) is common after cardiac surgery with cardiopulmonary bypass (CPB) and is associated with increased mortality and morbidity. Nadir indexed oxygen delivery (DO2i) lower than the critical threshold during CPB is a risk factor for postoperative AKI. The critical DO2i for preventing AKI in children has not been well studied. The study aimed to explore the association between nadir DO2i and postoperative AKI in infant cardiac surgery with CPB.MethodsFrom August 2021 to July 2022, 413 low-weight infants (≤10 kg) undergoing cardiac surgery with CPB were consecutively enrolled in this prospective observational study. Nadir DO2i was calculated during the hypothermia and rewarming phases of CPB, respectively. The association between nadir DO2i and postoperative AKI was investigated in mild hypothermia (32–34°C) and moderate hypothermia (26–32°C).ResultsA total of 142 (38.3%) patients developed postoperative AKI. In patients undergoing mild hypothermia during CPB, nadir DO2i in hypothermia and rewarming phases was independently associated with postoperative AKI. The cutoff values of nadir DO2i during hypothermia and rewarming phases were 258 mL/min/m2 and 281 mL/min/m2, respectively. There was no significant association between nadir DO2i and postoperative AKI in patients undergoing moderate hypothermia during CPB.ConclusionIn low-weight infants undergoing mild hypothermia during CPB, the critical DO2i for preventing AKI was 258 mL/min/m2 in the hypothermia phase and 281 mL/min/m2 for rewarming. Moreover, an individualized critical DO2i threshold should be advocated during CPB.

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“…[7,8] Several parameters have been proposed as indicators to re ect renal oxygenation such as oxygen delivery index and urinary oxygen tension. [9,10] However, direct monitoring of renal perfusion and oxygenation is di cult. Near-infrared spectroscopy (NIRS) allows a non-invasive and continuous approach to monitor oxygenation balance of regional tissues.…”

Section: Introductionmentioning

confidence: 99%

Association of intra-operative muscular tissue oxygen saturation with postoperative acute kidney injury in older patients undergoing major abdominal surgery: A prospective cohort study

Yin

Wang

Zhao

et al. 2022

Preprint

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Purpose Acute kidney injury (AKI) is frequently associated with poor postoperative prognoses. Intra-operative renal ischaemia and hypoxia may contribute to the pathogenesis of postoperative AKI. However, direct monitoring of this condition is difficult. Although near-infrared spectroscopy (NIRS) measurements of muscle tissue oxygen saturation (SmtO2) can predict some postoperative adverse outcomes, their association with AKI in older patients undergoing major abdominal surgery is unclear. Methods This prospective observational study recruited a total of 253 patients aged ≥65 years undergoing ≥2-h-long elective abdominal surgeries from September 2021 to August 2022. NIRS monitoring of bilateral flank, quadriceps, and brachioradialis muscles was performed throughout the surgery. The primary outcome was the incidence of AKI , diagnosed using the Kidney Disease: Improving Global Outcomes criteria, within 7 days postoperatively. Results AKI occurred in 44/240 patients (18.3%) and was associated with worse secondary outcomes. SmtO2 decline >10% of the baseline values at the right flank (OR, 6.98; 95% CI 1.36 to 35.83; P=0.020), left flank (OR, 6.69; 95% CI 1.55 to 28.9; P=0.011), quadriceps (OR, 2.99; 95% CI 1.36 to 6.55; P=0.006) was associated with AKI. The standard deviation values of SmtO2 at the right flank (OR, 3.32; 95% CI 1.72 to 6.41; P<0.001) and left flank (OR, 1.37; 95% CI 1.01 to 1.86; P=0.048) were also associated with an increased risk of AKI. The area under the curve for SmtO2 measurements 10%, and 5% below the baseline at the right flank and quadriceps were associated with an increased risk of AKI. Conclusion SmtO2 is associated with postoperative AKI and may facilitate prevention of AKI.

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Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery

Cited by 6 publications

References 39 publications

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action

Nadir oxygen delivery is associated with postoperative acute kidney injury in low-weight infants undergoing cardiopulmonary bypass

Association of intra-operative muscular tissue oxygen saturation with postoperative acute kidney injury in older patients undergoing major abdominal surgery: A prospective cohort study

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