Goal-directed perfusion to reduce acute kidney injury: A randomized trial

The Journal of Thoracic and Cardiovascular Surgery
Marco RanucciValeria Pistuddi

Abstract

To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2) at ≥280 mL·min-1·m-2 reduces the incidence of acute kidney injury (AKI). This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at ≥280 mL·min-1·m-2. The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality. Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, ...Continue Reading

Citations

Oct 3, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alexander WahbaUNKNOWN EACTS/EACTA/EBCP Committee Reviewers
Nov 7, 2019·Anesthesiology·Sam D GumbertHolger K Eltzschig
Feb 26, 2020·Journal of Clinical Medicine·Won Ho KimKyung-Suk Suh
Dec 15, 2019·BMC Cardiovascular Disorders·Marceli LukaszewskiMarek Jasinski
Apr 1, 2020·Perfusion·Geoffrey Lockwood
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Mar 10, 2021·Journal of Cardiac Surgery·Siddharth PahwaJuan Crestanello
Feb 2, 2021·The Annals of Thoracic Surgery·Yan ZhangRong-Hua Zhou
Apr 13, 2021·The Journal of Thoracic and Cardiovascular Surgery·Hiroshi MukaidaAtsushi Amano
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