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J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927.e2. doi: 10.1016/j.jtcvs.2018.04.045. Epub 2018 Apr 18.

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

Author information

1
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. Electronic address: cardioanestesia@virgilio.it.
2
Department of Perfusion, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Anesthesia, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
3
Green Lane Cardiothoracic Unit and Cardiothoracic and Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand; Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
4
Cardiac Research and Perfusion, Cardiac and Thoracic Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
5
Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
6
Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany; Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany.
7
Department of Perfusion, University of Colorado Denver, Aurora, Colo; Department of Anesthesiology, University of Colorado Denver, Aurora, Colo.
8
Heart Centre, University Hospital Ghent, Ghent, Belgium.
9
Department of Cardiothoracic Surgery, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom.
10
Department of Clinical Sciences and Community Health, University of Milan, and IRCCS Policlinico San Donato, Milan, Italy.
11
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.

Abstract

OBJECTIVE:

To 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).

METHODS:

This 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.

RESULTS:

Acute 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).

CONCLUSIONS:

A 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).

KEYWORDS:

acute kidney injury; cardiac surgery; cardiopulmonary bypass; oxygen delivery

PMID:
29778331
DOI:
10.1016/j.jtcvs.2018.04.045
[Indexed for MEDLINE]

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