Acquired: Perioperative management: Cardiac
A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery

Read at the 96th Annual Meeting of The American Association for Thoracic Surgery, Baltimore, Maryland, May 14-18, 2016.
https://doi.org/10.1016/j.jtcvs.2016.09.016Get rights and content
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Abstract

Background

We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery.

Methods

On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m2 and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery.

Results

We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m2, P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001).

Conclusions

The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study.

Key Words

acute kidney injury
cardiopulmonary bypass
CPB inflammatory response
goal-directed perfusion
kidney
postoperative care
renal failure

Abbreviations and Acronyms

AKI
acute kidney injury
BSA
body surface area
CPB
cardiopulmonary bypass
DO2
oxygen delivery
GDP
goal-directed perfusion
GFR
glomerular filtration rate
ICU
intensive care unit
IQR
interquartile range
MAP
mean arterial pressure
NIRS
near-infrared spectroscopy
PVD
peripheral vascular disease
RAP
retrograde autologous priming
ZBUF
zero-balance ultrafiltration

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