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O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?

Authors
  • de Somer, Filip1
  • Mulholland, John W2
  • Bryan, Megan R2
  • Aloisio, Tommaso3
  • Van Nooten, Guido J1
  • Ranucci, Marco3
  • 1 Universitair Ziekenhuis Gent, Department of Interventional and Surgical Cardiology, Heart Centre, De Pintelaan 185, Gent, B-9000, Belgium , Gent (Belgium)
  • 2 Basildon University Hospital, Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Nethermayne, Basildon, SS16 5NL, Essex,UK , Basildon (United Kingdom)
  • 3 IRCCS Policlinico San Donato, Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, Via Morandi 30,I-20097, MilanSan Donato Milanese, SS16 5NL, Italy , MilanSan Donato Milanese (Italy)
Type
Published Article
Journal
Critical Care
Publisher
BioMed Central
Publication Date
Aug 10, 2011
Volume
15
Issue
4
Identifiers
DOI: 10.1186/cc10349
Source
Springer Nature
Keywords
License
Yellow

Abstract

IntroductionAcute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery (DO2) and carbon dioxide production (VCO2)) during CPB with postoperative AKI.MethodsWe conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The DO2 and VCO2 levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir DO2 values and nadir DO2/VCO2 ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage.ResultsA nadir DO2 level < 262 mL/minute/m2 and a nadir DO2/VCO2 ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir DO2 levels and nadir DO2/VCO2 ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir DO2 level.ConclusionsThe nadir DO2 level during CPB is independently associated with postoperative AKI. The measurement of VCO2-related variables does not add accuracy to the AKI prediction. Since DO2 during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the DO2 level above the identified critical value might limit the incidence of postoperative AKI.

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