Goal-directed perfusion to reduce acute kidney injury: A randomized trial

The Journal of Thoracic and Cardiovascular Surgery

Andreas Baumann¹  Christa Boer²  Paul Exton³  Timothy Willcox⁴  George A. Justison⁵  Richard F. Newland⁶  Seema Agarwal⁷  Filip de Somer⁸  Dirk Buchwald⁹  Marco Ranucci^1,10  Ian Johnson^1,11  Rachael Parke^1,12  Robert A. Baker^1,13  Renard G. Haumann^1,14 

[1] Cardiac Research and Perfusion, Cardiac and Thoracic Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia;Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany;Department of Anesthesia, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom;Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands;Department of Anesthesiology, University of Colorado Denver, Aurora, Colo;Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany;Department of Cardiothoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands;Department of Cardiothoracic Surgery, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom;Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy;Department of Perfusion, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom;Department of Perfusion, University of Colorado Denver, Aurora, Colo;Green Lane Cardiothoracic Unit and Cardiothoracic and Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand;Heart Centre, University Hospital Ghent, Ghent, Belgium

关键词: cardiac surgery;    cardiopulmonary bypass;    oxygen delivery;    acute kidney injury;   

DOI  :  10.1016/j.jtcvs.2018.04.045

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2) at ≥280 mL·min−1·m−2 reduces the incidence of acute kidney injury (AKI).MethodsThis multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at ≥280 mL·min−1·m−2. The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality.ResultsAcute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with an RR for AKI of 0.49 (95% CI, 0.27-0.89; P = .017).ConclusionsA GDP strategy is effective in reducing AKIN stage 1 AKI. Further studies are needed to define perfusion interventions that may reduce more severe levels of renal injury (AKIN stage 2 or 3).

【 授权许可】

Unknown