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Title: Dynamic responses of renal oxygenation at the onset of cardiopulmonary bypass in sheep and man.
Austin Authors: Evans, Roger G;Cochrane, Andrew D;Hood, Sally G;Iguchi, Naoya;Marino, Bruno;Bellomo, Rinaldo ;McCall, Peter R ;Okazaki, Nobuki;Smith, Julian A;Zhu, Michael Zl;Ngo, Jennifer P;Noe, Khin M;Martin, Andrew;Thrift, Amanda G;Lankadeva, Yugeesh R;May, Clive N
Affiliation: Department of Anesthesiology and Resuscitology, Okayama University, Okayama, Japan
Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
Intensive Care
Cellsaving and Perfusion Resources, Melbourne, Victoria, Australia
Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
Issue Date: 2022
Date: 2021
Publication information: Perfusion 2022; 37(6): 624-632
Abstract: The renal medulla is susceptible to hypoxia during cardiopulmonary bypass (CPB), which may contribute to the development of acute kidney injury. But the speed of onset of renal medullary hypoxia remains unknown. We continuously measured renal medullary oxygen tension (MPO2) in 24 sheep, and urinary PO2 (UPO2) as an index of MPO2 in 92 patients, before and after induction of CPB. In laterally recumbent sheep with a right thoracotomy (n = 20), even before CPB commenced MPO2 fell from (mean ± SEM) 52 ± 4 to 41 ±5 mmHg simultaneously with reduced arterial pressure (from 108 ± 5 to 88 ± 5 mmHg). In dorsally recumbent sheep with a medial sternotomy (n = 4), MPO2 was even more severely reduced (to 12 ± 12 mmHg) before CPB. In laterally recumbent sheep in which a crystalloid prime was used (n = 7), after commencing CPB, MPO2 fell abruptly to 24 ±6 mmHg within 20-30 minutes. MPO2 during CPB was not improved by adding donor blood to the prime (n = 13). In patients undergoing cardiac surgery, UPO2 fell by 4 ± 1 mmHg and mean arterial pressure fell by 7 ± 1 mmHg during the 30 minutes before CPB. UPO2 then fell by a further 12 ± 2 mmHg during the first 30 minutes of CPB but remained relatively stable for the remaining 24 minutes of observation. Renal medullary hypoxia is an early event during CPB. It starts to develop even before CPB, presumably due to a pressure-dependent decrease in renal blood flow. Medullary hypoxia during CPB appears to be promoted by hypotension and is not ameliorated by increasing blood hemoglobin concentration.
DOI: 10.1177/02676591211013640
ORCID: 0000-0002-9241-0757
Journal: Perfusion
PubMed URL: 33977810
Type: Journal Article
Subjects: acute kidney injury
cardiac surgery
renal circulation
Appears in Collections:Journal articles

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