Pharmacological and non‐surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review

Tan, Shijie Ian; Brewster, David; Horrigan, Diane; Sarode, Vineet

doi:10.1111/ans.14800

Cited by 12 publications

(17 citation statements)

References 38 publications

(42 reference statements)

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“…However, there is no evidence that more commonly used agents, such as sevoflurane or propofol/fentanyl, are more renoprotective than isoflurane. 27 We acknowledge the limitations of laser Doppler flowmetry, which is an index of erythrocyte velocity in highly perfused tissues such as the kidney. 28 We studied young adult sheep, so our findings are more relevant to young healthy patients than older patients with comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Lankadeva

Cochrane

Marino

et al. 2019

Kidney International

107

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Renal medullary hypoxia may contribute to cardiac surgery-associated acute kidney injury (AKI). However, the effects of cardiopulmonary bypass (CPB) on medullary oxygenation are poorly understood. Here we tested whether CPB causes medullary hypoxia and whether medullary oxygenation during CPB can be improved by increasing pump flow or mean arterial pressure (MAP). Twelve sheep were instrumented to measure whole kidney, medullary, and cortical blood flow and oxygenation. Five days later, under isoflurane anesthesia, CPB was initiated at a pump flow of 80 mL kg -1 min -1 and target MAP of 70 mm Hg. Pump flow was then set at 60 and 100 mL kg -1 min -1 , while MAP was maintained at approximately 70 mm Hg. MAP was then increased by vasopressor (metaraminol, 0.2-0.6 mg/min) infusion at a pump flow of 80 mL kg -1 min -1 . CPB at 80 mL kg -1 min -1 reduced renal blood flow (RBF), -61% less than the conscious state, perfusion in the cortex (-44%) and medulla (-40%), and medullary PO 2 from 43 to 27 mm Hg. Decreasing pump flow from 80 to 60 mL kg -1 min -1 further decreased RBF (-16%) and medullary PO 2 from 25 to 14 mm Hg. Increasing pump flow from 80 to 100 mL kg -1 min -1 increased RBF (17%) and medullary PO 2 from 20 to 29 mm Hg. Metaraminol (0.2 mg/min) increased MAP from 63 to 90 mm Hg, RBF (47%), and medullary PO 2 from 19 to 39 mm Hg. Thus, the renal medulla is susceptible to hypoxia during CPB, but medullary oxygenation can be improved by increasing pump flow or increasing target MAP by infusion of metaraminol.A KI occurs in more than 20% of adult patients after cardiac surgery requiring CPB. 1 The ability to decrease the risk of AKI associated with cardiac surgery is hampered by our lack of knowledge of the effects of CPB on renal perfusion and oxygenation. 2 Evolving evidence shows that renal medullary hypoxia contributes to the development of AKI. 3,4 Mathematical models predict renal medullary hypoxia during CPB, 5,6 and medullary hypoxia has been observed in a rat model of CPB 7 and in a pilot study of 2 pigs subjected to CPB. 8 However, there have been no systematic investigations of renal global and regional (i.e., cortical and medullary) perfusion and oxygenation in a clinically relevant large animal model of CPB. Furthermore, although evidence shows that goaldirected perfusion can mitigate risk of postoperative AKI 9-11 and that the increase in renal fractional oxygen extraction during CPB can be alleviated by increasing pump flow, 12,13 the potential for perfusion conditions to be

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Section: Discussionmentioning

confidence: 99%

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Lankadeva

Cochrane

Marino

et al. 2019

Kidney International

107

View full text Add to dashboard Cite

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“…Approximately 2 million coronary artery bypass graft procedures or valve replacement/repair procedures requiring CPB are performed annually worldwide (Hu et al, 2016). Major unresolved clinical complications arising from CPB include the development of post‐operative cognitive dysfunction (Tan, Brewster, Horrigan, & Sarode, 2018) and AKI (Evans et al, 2018; Kellum & Prowle, 2018). Short‐term post‐operative cognitive dysfunction occurs in 20–50% of patients after CPB, and 10–30% of these patients develop long‐term cognitive disabilities (Tan et al, 2018).…”

Section: Organ Dysnfunction Arising From Cardiac Surgerymentioning

confidence: 99%

“…Major unresolved clinical complications arising from CPB include the development of post‐operative cognitive dysfunction (Tan, Brewster, Horrigan, & Sarode, 2018) and AKI (Evans et al, 2018; Kellum & Prowle, 2018). Short‐term post‐operative cognitive dysfunction occurs in 20–50% of patients after CPB, and 10–30% of these patients develop long‐term cognitive disabilities (Tan et al, 2018). Similarly, the incidence of post‐operative AKI is approximately 22% in patients undergoing CPB (Hu et al, 2016).…”

Section: Organ Dysnfunction Arising From Cardiac Surgerymentioning

confidence: 99%

“…(Hu et al, 2016). Major unresolved clinical complications arising from CPB include the development of postoperative cognitive dysfunction (Tan, Brewster, Horrigan, & Sarode, 2018) and AKI (Evans et al, 2018;Kellum & Prowle, 2018).…”

Section: Clinical Trials Using Dexmedetomidine In Sepsismentioning

confidence: 99%

“…of patients after CPB, and 10-30% of these patients develop longterm cognitive disabilities (Tan et al, 2018). Similarly, the incidence of post-operative AKI is approximately 22% in patients undergoing CPB (Hu et al, 2016).…”

Section: Clinical Trials Using Dexmedetomidine In Sepsismentioning

confidence: 99%

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Emerging benefits and drawbacks of α₂‐adrenoceptor agonists in the management of sepsis and critical illness

Lankadeva

Shehabi

Deane

et al. 2021

British J Pharmacology

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Agonists of α2‐adrenoceptors are increasingly being used for the provision of comfort, sedation and the management of delirium in critically ill patients, with and without sepsis. In this context, increased sympathetic and inflammatory activity are common pathophysiological features linked to multi‐organ dysfunction, particularly in patients with sepsis or those undergoing cardiac surgery requiring cardiopulmonary bypass. Experimental and clinical studies support the notion that the α2‐adrenoceptor agonists, dexmedetomidine and clonidine, mitigate sympathetic and inflammatory overactivity in sepsis and cardiac surgery requiring cardiopulmonary bypass. These effects can protect vital organs, including the cardiovascular system, kidneys, heart and brain. We review the pharmacodynamic mechanisms by which α2‐adrenoceptor agonists might mitigate multi‐organ dysfunction arising from pathophysiological conditions associated with excessive inflammatory and adrenergic stress in experimental studies. We also outline recent clinical trials that have examined the use of dexmedetomidine in critically ill patients with and without sepsis and in patients undergoing cardiac surgery.

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Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality

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Bilker,

Huang

et al. 2024

Pediatr Cardiol

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Pharmacological and non‐surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review

Cited by 12 publications

References 38 publications

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Emerging benefits and drawbacks of α₂‐adrenoceptor agonists in the management of sepsis and critical illness

Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality

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Pharmacological and non‐surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review

Cited by 12 publications

References 38 publications

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

Emerging benefits and drawbacks of α2‐adrenoceptor agonists in the management of sepsis and critical illness

Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality

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Product

Resources

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Emerging benefits and drawbacks of α₂‐adrenoceptor agonists in the management of sepsis and critical illness