Ghent University Academic Bibliography

Advanced

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

Filip De Somer UGent, John W Mulholland, Megan R Bryan, Tommaso Aloisio, Guido Van Nooten UGent and Marco Ranucci (2011) CRITICAL CARE. 15(4).
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.
Please use this url to cite or link to this publication:
author
organization
alternative title
O-2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury : time for a goal-directed perfusion management?
year
type
journalArticle (original)
publication status
published
subject
keyword
HEMATOCRIT, OUTCOMES, RISK-FACTORS, ANAEROBIC METABOLISM, OXYGEN DELIVERY, ACUTE-RENAL-FAILURE, CARDIAC-SURGERY, IMPACT, DYSFUNCTION, HYPOXIA
journal title
CRITICAL CARE
Crit. Care
volume
15
issue
4
article number
R192
pages
10 pages
Web of Science type
Article
Web of Science id
000298082800032
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
4.607 (2011)
JCR rank
5/26 (2011)
JCR quartile
1 (2011)
ISSN
1466-609X
DOI
10.1186/cc10349
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
2006794
handle
http://hdl.handle.net/1854/LU-2006794
date created
2012-01-27 16:08:41
date last changed
2016-12-21 15:42:37
@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},
}

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.