Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass.

Autor: Ayers BC; Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Padrós-Valls R; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Bioinformatics and Systems Biology, University of California, San Diego, San Diego, CA., Brownlee S; Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Steinhorn BS; Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Shann K; Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Osho A; Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Sundt TM; Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Aguirre AD; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA. Electronic address: aaguirre1@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Nov 12. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1053/j.jvca.2024.11.010
Abstrakt: Objectives: Optimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI).
Design: Retrospective cohort study.
Setting: Single tertiary care hospital PARTICIPANTS: We included 1,038 adult cardiac surgery patients who underwent CPB.
Interventions: Pcrit was calculated using arterial waveform data before initiation of CPB. Pcrit was examined in relation to incidence of stage 2 or higher postoperative AKI according to standard Kidney Disease Improving Global Outcomes definitions.
Measurements and Main Results: Of the 1,038 patients included in the study, 50 (5%) experienced AKI. Patients who suffered AKI had significantly higher preoperative risk factors, including higher incidence of severe chronic kidney disease and higher Society of Thoracic Surgeons risk score (p < 0.01). They also had longer operative times and longer cross-clamp times (p < 0.01). All patients were maintained at similar mean arterial pressure while on CPB. Patients who suffered AKI had a significantly higher prebypass Pcrit than those who did not (49.0 mmHg vs 44.1 mmHg; p = 0.018). In a multivariate regression, Pcrit remained a significant predictor, representing a 16% increased risk of AKI for each 5 mmHg increase in prebypass Pcrit (p = 0.011).
Conclusions: A higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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