Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial
Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether managem...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-12-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/24/7746 |
| _version_ | 1797380536561303552 |
|---|---|
| author | Alicia Molina-Andujar José Rios Gaston J. Piñeiro Elena Sandoval Cristina Ibañez Eduard Quintana Purificación Matute Rut Andrea Teresa Lopez-Sobrino Jordi Mercadal Enric Reverter Irene Rovira Ana Maria Villar Sara Fernandez Manel Castellà Esteban Poch |
| author_facet | Alicia Molina-Andujar José Rios Gaston J. Piñeiro Elena Sandoval Cristina Ibañez Eduard Quintana Purificación Matute Rut Andrea Teresa Lopez-Sobrino Jordi Mercadal Enric Reverter Irene Rovira Ana Maria Villar Sara Fernandez Manel Castellà Esteban Poch |
| author_sort | Alicia Molina-Andujar |
| collection | DOAJ |
| description | Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, <i>p</i> = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, <i>p</i> = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, <i>p</i> = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (<i>p</i> = 0.40). There were no differences in extrarenal complications between groups as well. Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study. |
| first_indexed | 2024-03-08T20:38:43Z |
| format | Article |
| id | doaj.art-42b1dd1289c24dab809e0a937376f1f6 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T20:38:43Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-42b1dd1289c24dab809e0a937376f1f62023-12-22T14:17:38ZengMDPI AGJournal of Clinical Medicine2077-03832023-12-011224774610.3390/jcm12247746Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled TrialAlicia Molina-Andujar0José Rios1Gaston J. Piñeiro2Elena Sandoval3Cristina Ibañez4Eduard Quintana5Purificación Matute6Rut Andrea7Teresa Lopez-Sobrino8Jordi Mercadal9Enric Reverter10Irene Rovira11Ana Maria Villar12Sara Fernandez13Manel Castellà14Esteban Poch15Nephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, SpainDepartment of Clinical Farmacology, Hospital Clinic and Medical Statistics Core Facility, 08036 Barcelona, SpainNephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, SpainCardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, SpainAnesthesiology Department, Hospital Clínic, 08036 Barcelona, SpainCardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, SpainAnesthesiology Department, Hospital Clínic, 08036 Barcelona, SpainInstitut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainInstitut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainAnesthesiology Department, Hospital Clínic, 08036 Barcelona, SpainLiver and Digestive ICU, Liver Unit, Hospital Clínic, 08036 Barcelona, SpainAnesthesiology Department, Hospital Clínic, 08036 Barcelona, SpainPerfusion Department, Hospital Clínic, 08036 Barcelona, SpainMedical Intensive Care Unit, Hospital Clínic, 08036 Barcelona, SpainCardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, SpainNephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, SpainBackground: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, <i>p</i> = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, <i>p</i> = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, <i>p</i> = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (<i>p</i> = 0.40). There were no differences in extrarenal complications between groups as well. Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study.https://www.mdpi.com/2077-0383/12/24/7746acute kidney injurycardiac surgerymean perfusion pressurepreventionclinical trial |
| spellingShingle | Alicia Molina-Andujar José Rios Gaston J. Piñeiro Elena Sandoval Cristina Ibañez Eduard Quintana Purificación Matute Rut Andrea Teresa Lopez-Sobrino Jordi Mercadal Enric Reverter Irene Rovira Ana Maria Villar Sara Fernandez Manel Castellà Esteban Poch Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial Journal of Clinical Medicine acute kidney injury cardiac surgery mean perfusion pressure prevention clinical trial |
| title | Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial |
| title_full | Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial |
| title_fullStr | Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial |
| title_full_unstemmed | Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial |
| title_short | Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial |
| title_sort | assessment of individualized mean perfusion pressure targets for the prevention of cardiac surgery associated acute kidney injury the prevhemaki randomized controlled trial |
| topic | acute kidney injury cardiac surgery mean perfusion pressure prevention clinical trial |
| url | https://www.mdpi.com/2077-0383/12/24/7746 |
| work_keys_str_mv | AT aliciamolinaandujar assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT joserios assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT gastonjpineiro assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT elenasandoval assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT cristinaibanez assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT eduardquintana assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT purificacionmatute assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT rutandrea assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT teresalopezsobrino assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT jordimercadal assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT enricreverter assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT irenerovira assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT anamariavillar assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT sarafernandez assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT manelcastella assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial AT estebanpoch assessmentofindividualizedmeanperfusionpressuretargetsforthepreventionofcardiacsurgeryassociatedacutekidneyinjurytheprevhemakirandomizedcontrolledtrial |