Dynamic responses of renal oxygenation at the onset of cardiopulmonary bypass in sheep and man
| Autor: | Yugeesh R Lankadeva, Andrew D. Cochrane, Clive N. May, Bruno Marino, Jennifer P. Ngo, Peter R McCall, Michael Z.L. Zhu, Amanda G. Thrift, Nobuki Okazaki, Julian A. Smith, Khin M. Noe, Naoya Iguchi, Sally G Hood, Roger G. Evans, Rinaldo Bellomo, Andrew J. Martin |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
030204 cardiovascular system & hematology Renal oxygenation law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law Internal medicine medicine Cardiopulmonary bypass Renal medulla Animals Humans Radiology Nuclear Medicine and imaging Hypoxia Advanced and Specialized Nursing Kidney Medulla Cardiopulmonary Bypass Sheep Renal circulation business.industry Acute kidney injury General Medicine Acute Kidney Injury Hypoxia (medical) medicine.disease Cardiac surgery Oxygen medicine.anatomical_structure Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business Safety Research Perfusion |
| Zdroj: | Perfusion. 37:624-632 |
| ISSN: | 1477-111X 0267-6591 |
| DOI: | 10.1177/02676591211013640 |
| Popis: | Introduction: 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. Methods: 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. Results: 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. Conclusions: 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. |
| Databáze: | OpenAIRE |
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