• J. Cardiothorac. Vasc. Anesth. · Nov 2022

    Association of Preoperative Pulse Pressure and Oxygen Delivery Index During Cardiopulmonary Bypass With Postoperative Acute Kidney Injury.

    • Ludmil Mitrev, Casey Krickus, James DeChiara, Robert Huseby, Neil Desai, and Noud van Helmond.
    • Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Cooper University Hospital, Camden, NJ, United States; Cooper Medical School of Rowan University, Camden, NJ, United States. Electronic address: Mitrev-Ludmil@cooperhealth.edu.
    • J. Cardiothorac. Vasc. Anesth. 2022 Nov 1; 36 (11): 407040764070-4076.

    ObjectiveTo investigate if oxygen delivery index during cardiopulmonary bypass (DO2I) was more strongly associated with acute kidney injury (AKI), the higher the patient's preoperative pulse pressure (PP).DesignRetrospective cohort of 1064 patients undergoing cardiac surgery.SettingSingle academic healthcare center.ParticipantsAdult patients undergoing coronary artery bypass grafting, valve, aortic, or combined surgery requiring cardiopulmonary bypass.InterventionsHemoglobin, arterial oxygen saturation, and pump flow recorded no fewer than every 30 min were extracted from the patients' perfusion records, and DO2I was calculated. The AKI was assessed from the pre- and postoperative creatinine and urine output values using the Acute Kidney Injury Network criteria. The sample was stratified in 5 categories of progressively higher PP. The patient characteristics and intraoperative variables were evaluated in univariate analysis for a relationship with AKI. The significant risk factors from the univariate analysis then were evaluated in a multivariate analysis and assessed for logistic fit with respect to AKI.Primary OutcomeThe AKI assessed as a binary outcome.Measurements And Main ResultsAge, body surface area, DO2I, history of heart failure, and baseline creatinine were associated significantly with AKI, as was an interaction term between the PP category and DO2I (p = 0.0067). The higher the PP category, the stronger the observed association between DO2I and AKI, and the higher the variability in the predicted risk of AKI dependent on DO2I.ConclusionsA lower DO2I during cardiopulmonary bypass appeared more strongly associated with a higher likelihood of developing AKI, the higher the patient's preoperative pulse pressure.Copyright © 2022 Elsevier Inc. All rights reserved.

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