Hiroshi Mukaida1, Satoshi Matsushita2, Kenji Kuwaki3, Takahiro Inotani4, Yuki Minami4, Akira Saigusa4, Atsushi Amano3. 1. Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan; Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan. 2. Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan. Electronic address: saty-m@juntendo.ac.jp. 3. Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan. 4. Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan.
Abstract
OBJECTIVE: Previous studies have reported that nadir oxygen delivery during cardiopulmonary bypass is associated with the occurrence of postoperative acute kidney injury (AKI). However, these measurements only considered the bottom point of the oxygen delivery (DO2) but did not consider the duration of DO2. We aimed to examine whether the time-dose response of DO2 during cardiopulmonary bypass can be used to estimate the risk for postoperative AKI. METHODS: We evaluated 112 patients who underwent cardiac surgeries with cardiopulmonary bypass. We analyzed the perfusion parameters recorded every 20 seconds. To obtain time-dose response of DO2 index (DO2i), the area under the curve was calculated as below the 300 mL/min/m2 threshold, which accounts for depth and duration of cumulative oxygen debt. In addition, the cumulative time below DO2i 300 mL/min/m2 was also calculated. Receiver operating characteristic analysis, univariate regression analysis, and multivariate regression analysis were used to evaluate associations between perioperative variables and postoperative AKI. RESULTS: Patients who developed AKI had larger area under the curve below the 300 mL/min/m2 threshold (1581 vs 632; P < .01) and cumulative time below DO2i 300 mL/min/m2 (34.7 vs 15.3 minutes; P < .01). Nadir DO2i was not significantly different between the non-AKI and AKI groups (263.4 vs 247.0 mL/min/m2; P = .291). CONCLUSIONS: The time-dose response of DO2i during cardiopulmonary bypass is a better indicator than nadir DO2i in evaluating AKI risk. Maintaining DO2i levels >300 mL/min/m2 may result in decreased risk for postoperative AKI.
OBJECTIVE: Previous studies have reported that nadiroxygen delivery during cardiopulmonary bypass is associated with the occurrence of postoperative acute kidney injury (AKI). However, these measurements only considered the bottom point of the oxygen delivery (DO2) but did not consider the duration of DO2. We aimed to examine whether the time-dose response of DO2 during cardiopulmonary bypass can be used to estimate the risk for postoperative AKI. METHODS: We evaluated 112 patients who underwent cardiac surgeries with cardiopulmonary bypass. We analyzed the perfusion parameters recorded every 20 seconds. To obtain time-dose response of DO2 index (DO2i), the area under the curve was calculated as below the 300 mL/min/m2 threshold, which accounts for depth and duration of cumulative oxygen debt. In addition, the cumulative time below DO2i 300 mL/min/m2 was also calculated. Receiver operating characteristic analysis, univariate regression analysis, and multivariate regression analysis were used to evaluate associations between perioperative variables and postoperative AKI. RESULTS:Patients who developed AKI had larger area under the curve below the 300 mL/min/m2 threshold (1581 vs 632; P < .01) and cumulative time below DO2i 300 mL/min/m2 (34.7 vs 15.3 minutes; P < .01). NadirDO2i was not significantly different between the non-AKI and AKI groups (263.4 vs 247.0 mL/min/m2; P = .291). CONCLUSIONS: The time-dose response of DO2i during cardiopulmonary bypass is a better indicator than nadirDO2i in evaluating AKI risk. Maintaining DO2i levels >300 mL/min/m2 may result in decreased risk for postoperative AKI.
Authors: Elena Carrasco-Serrano; Pablo Jorge-Monjas; María Fé Muñoz-Moreno; Esther Gómez-Sánchez; Juan Manuel Priede-Vimbela; Miguel Bardají-Carrillo; Héctor Cubero-Gallego; Eduardo Tamayo; Christian Ortega-Loubon Journal: J Clin Med Date: 2022-05-28 Impact factor: 4.964