• Pierre-Grégoire Guinot, Pierre Huette, Belaid Bouhemad, Osama Abou-Arab, and Maxime Nguyen.
• Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France. Electronic address: guinotpierregregoire@gmail.com.
• J Clin Anesth. 2023 Sep 1; 88: 111124111124.

Study ObjectiveTo evaluate the impact of a dynamic arterial elastance guided norepinephrine weaning strategy on the occurrence of acute kidney injury (AKI) in patients with vasoplegia after cardiac surgery.DesignA post-hoc analysis of a monocentric randomized controlled trial.SettingA tertiary care hospital in France.ParticipantsVasoplegic cardiac surgical patients treated with norepinephrine.InterventionPatients were randomized to an algorithm-based norepinephrine weaning intervention (dynamic arterial elastance) group or a control group.MeasurementsThe primary endpoint was the number of patients with AKI defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The secondary endpoint were major adverse cardiac post-operative events (new onset of atrial fibrillation or flutter, low cardiac output syndrome, and in-hospital death). End points were evaluated during the first seven post-operative days.Results118 patients were analyzed. In the overall study population, the mean age was 70 (62-76) years, 65% were male and the median EuroSCORE was 7 (5-10). Overall, 46 (39%) patients developed AKI (30 KDIGO 1, 8 KDIGO 2, 8 KDIGO 3), and 6 patients required renal replacement therapy. The incidence of AKI was significantly lower in the intervention group than in the control group (16 patients (27%) vs 30 patients (51%), p = 0.12). Higher dose and longer duration of norepinephrine were associated with AKI severity.ConclusionDecreasing norepinephrine exposure by using a dynamic arterial elastance guided norepinephrine weaning strategy was associated with a reduced incidence of acute kidney injury in patients with vasoplegia after cardiac surgery. Further prospective multicentric studies are needed to confirm these results.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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