实施目标导向灌注策略以减少心脏手术相关肾损伤：前后研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111828

Jules Loeb , Geoffroy Hariri , Vincenzo Montana , Aude Carillion , Axel Hirwe , Pauline Dureau , Nima Djavidi , Aymeric Lancelot , Pascal Leprince , Guillaume Lebreton , Adrien Bouglé

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引用次数: 0

摘要

目的心脏手术相关急性肾损伤（CSA-AKI）是一种常见且严重的并发症。体外循环（CPB）期间的目标定向灌注（GDP）已被开发用于减少术后并发症，特别是CSA-AKI。因此，我们旨在评估CPB期间GDP策略在大量未选择的心脏手术人群中对CSA-AKI发生率的实施情况。方法对实施GDP前一年（无GDP组）和实施GDP后一年（GDP组）在我院外科重症监护病房（ICU）接受CPB心脏手术的所有患者进行回顾性研究。根据KDIGO分级，主要终点为各组急性肾损伤（AKI）发生率。次要终点是ICU死亡率和住院时间，以及心脏手术后的主要术后并发症。采用多变量logistic回归模型评估AKI的危险因素。结果903例患者中，314例（34%）发生AKI。实施GDP策略后AKI发生率较低(n = 111；27.6% vs n = 203；40.5%, p <；0.001)。在多变量分析中，GDP是AKI降低的独立因素(OR 0.37, 95% CI [0.27-0.52], p <；0.001)。这种获益在1期AKI中显著，但在2期或3期AKI中不显著。GDP与术后ICU死亡率、住院时间或任何其他术后并发症的变化无关。结论CPB期间dp策略植入与术后AKI发生率降低相关。

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Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and after study

Purpose

Cardiac surgery associated acute kidney injury (CSA-AKI) is a frequent and severe complication. Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) has been developed to reduce post-operative complications, in particular CSA-AKI. Hence, we aimed to assess the implementation of a GDP strategy during CPB on the incidence of CSA-AKI in a large, unselected cardiac surgery population.

Methods

We conducted a retrospective, before and after study, including all patients admitted to our surgical intensive care unit (ICU) following a cardiac surgery with CPB in the year prior to GDP implementation (No-GDP group), and in the year following its implementation (GDP group). Primary endpoint was the incidence of acute kidney injury (AKI) according to KDIGO classification in each group. Secondary endpoints were ICU mortality and length of stay, and the main post-operative complications after cardiac surgery. Risk factors of AKI were evaluated using a multivariable logistic regression model.

Results

Among 903 patients in our analysis, 314 (34 %) developed AKI. The incidence of AKI was lower after the implementation of GDP strategy (n = 111; 27.6 % vs n = 203; 40.5 %, p < 0.001). In the multivariable analysis, GDP was an independent factor of AKI reduction (OR 0.37, 95 %CI [0.27–0.52], p < 0.001). This benefit was significant regarding stage 1 AKI, but not stage 2 or 3 AKI. GDP was not associated with a change in post-operative ICU mortality, length of stay or any other post-operative complication.

Conclusion

GDP strategy implantation during CPB is associated with a reduction of postoperative AKI.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.