Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33526
Title: Intraoperative hemodynamics and risk of cardiac surgery-associated acute kidney injury: An observation study and a feasibility clinical trial.
Austin Authors: Noe, Khin M;Don, Andrea;Cochrane, Andrew D;Zhu, Michael Z L;Ngo, Jennifer P;Smith, Julian A;Thrift, Amanda G;Vogiatjis, Johnny;Martin, Andrew;Bellomo, Rinaldo ;McMillan, James;Evans, Roger G
Affiliation: Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.;Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.;Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia.
Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.;Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.;Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia.
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Intensive Care
Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.;Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.;Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia.
Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
Perfusion Services Pty Ltd, Melbourne, Victoria, Australia.
Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.;Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.;Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.;Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Issue Date: 7-Aug-2023
Date: 2023
Publication information: Clinical and Experimental Pharmacology & Physiology 2023-08-07
Abstract: Targeting greater pump flow and mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) could potentially alleviate renal hypoxia and reduce the risk of postoperative acute kidney injury (AKI). Therefore, in an observational study of 93 patients undergoing on-pump cardiac surgery, we tested whether intraoperative hemodynamic management differed between patients who did and did not develop AKI. Then, in 20 patients, we assessed the feasibility of a larger-scale trial in which patients would be randomized to greater than normal target pump flow and MAP, or usual care, during CPB. In the observational cohort, MAP during hypothermic CPB averaged 68.8 ± 8.0 mmHg (mean ± SD) in the 36 patients who developed AKI and 68.9 ± 6.3 mmHg in the 57 patients who did not (p = 0.98). Pump flow averaged 2.4 ± 0.2 L/min/m2 in both groups. In the feasibility clinical trial, compared with usual care, those randomized to increased target pump flow and MAP had greater mean pump flow (2.70 ± 0.23 vs. 2.42 ± 0.09 L/min/m2 during the period before rewarming) and systemic oxygen delivery (363 ± 60 vs. 281 ± 45 mL/min/m2 ). Target MAP ≥80 mmHg was achieved in 66.6% of patients in the intervention group but in only 27.3% of patients in the usual care group. Nevertheless, MAP during CPB did not differ significantly between the two groups. We conclude that little insight was gained from our observational study regarding the impact of variations in pump flow and MAP on the risk of AKI. However, a clinical trial to assess the effects of greater target pump flow and MAP on the risk of AKI appears feasible.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33526
DOI: 10.1111/1440-1681.13812
ORCID: 0000-0001-9980-9640
0000-0002-9241-0757
Journal: Clinical and Experimental Pharmacology & Physiology
PubMed URL: 37549882
ISSN: 1440-1681
Type: Journal Article
Subjects: arterial pressure
cardiopulmonary bypass
clinical perfusion
pump flow
systemic oxygen delivery
Appears in Collections:Journal articles

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