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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?

(2011) CRITICAL CARE. 15(4).
Author
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Abstract
Introduction: Acute 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 (DO(2)) and carbon dioxide production (VCO(2))) during CPB with postoperative AKI. Methods: We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The DO(2) and VCO(2) 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 DO(2) values and nadir DO(2)/VCO(2) 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. Results: A nadir DO2 level < 262 mL/minute/m(2) and a nadir DO(2)/VCO(2) ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir DO(2) levels and nadir DO(2)/VCO(2) 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 DO(2) level. Conclusions: The nadir DO(2) level during CPB is independently associated with postoperative AKI. The measurement of VCO(2)-related variables does not add accuracy to the AKI prediction. Since DO(2) during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the DO(2) level above the identified critical value might limit the incidence of postoperative AKI.
Keywords
HEMATOCRIT, OUTCOMES, RISK-FACTORS, ANAEROBIC METABOLISM, OXYGEN DELIVERY, ACUTE-RENAL-FAILURE, CARDIAC-SURGERY, IMPACT, DYSFUNCTION, HYPOXIA

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Chicago
De Somer, Filip, John W Mulholland, Megan R Bryan, Tommaso Aloisio, Guido Van Nooten, and Marco Ranucci. 2011. “O2 Delivery and CO2 Production During Cardiopulmonary Bypass as Determinants of Acute Kidney Injury: Time for a Goal-directed Perfusion Management?” Critical Care 15 (4).
APA
De Somer, F., Mulholland, J. W., Bryan, M. R., Aloisio, T., Van Nooten, G., & Ranucci, M. (2011). O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? CRITICAL CARE, 15(4).
Vancouver
1.
De Somer F, Mulholland JW, Bryan MR, Aloisio T, Van Nooten G, Ranucci M. O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? CRITICAL CARE. 2011;15(4).
MLA
De Somer, Filip, John W Mulholland, Megan R Bryan, et al. “O2 Delivery and CO2 Production During Cardiopulmonary Bypass as Determinants of Acute Kidney Injury: Time for a Goal-directed Perfusion Management?” CRITICAL CARE 15.4 (2011): n. pag. Print.
@article{2006794,
  abstract     = {Introduction: Acute 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 (DO(2)) and carbon dioxide production (VCO(2))) during CPB with postoperative AKI. 
Methods: We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The DO(2) and VCO(2) 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 DO(2) values and nadir DO(2)/VCO(2) 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. 
Results: A nadir DO2 level {\textlangle} 262 mL/minute/m(2) and a nadir DO(2)/VCO(2) ratio {\textlangle} 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir DO(2) levels and nadir DO(2)/VCO(2) 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 DO(2) level. Conclusions: The nadir DO(2) level during CPB is independently associated with postoperative AKI. The measurement of VCO(2)-related variables does not add accuracy to the AKI prediction. Since DO(2) during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the DO(2) level above the identified critical value might limit the incidence of postoperative AKI.},
  articleno    = {R192},
  author       = {De Somer, Filip and Mulholland, John W and Bryan, Megan R and Aloisio, Tommaso and Van Nooten, Guido and Ranucci, Marco},
  issn         = {1466-609X},
  journal      = {CRITICAL CARE},
  keyword      = {HEMATOCRIT,OUTCOMES,RISK-FACTORS,ANAEROBIC METABOLISM,OXYGEN DELIVERY,ACUTE-RENAL-FAILURE,CARDIAC-SURGERY,IMPACT,DYSFUNCTION,HYPOXIA},
  language     = {eng},
  number       = {4},
  pages        = {10},
  title        = {O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?},
  url          = {http://dx.doi.org/10.1186/cc10349},
  volume       = {15},
  year         = {2011},
}

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