Abstract
Background and Aims
Technically assisted assessment of volume status before cardiac surgery may be useful to direct intraoperative fluid administration. Using a three-compartment physiologic tissue model, the body composition monitor (BCM, In Body) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. Fluid overload is a risk factor for infection, increased re intubation rates, pneumonia and acute kidney injury in these high risk patients. This study is planned to use BCM to assess fluid status in patients undergoing cardiac surgery and correlating it with the risk of AKI
AIMS: To do BCM analysis of patients undergoing major cardiac surgery to assess fluid status and renal outcomes
Primary Objective To use BCM to assess fluid status in patients undergoing cardiac surgery and correlate it with the risk of acute kidney injury
Secondary Objectives To assess the correlation of fluid status obtained by BCM to assess
1. In hospital mortality in patients with and without AKI
Method
The studyis being conducted at Madras Medical Mission, Chennai.
Time period : 1 year ( June 1 2019- May 31 2020)
Inclusion criteria All consecutive patients above 18 years of age undergoing cardiac surgery
Exclusion criteria 1. No informed consent
2. Patients having metal implants, pace makers
3. Pregnant and lactating mothers
After informed consent, all adult patients undergoing cardiac surgery will have a BCM analysis done by the dietician .( Free of Charge) The BCM analysisInbody S10) will be done on Day 0( preoperative), Day 2 and Day 5 . Data will be collected according to a set proforma ( Attached) . Analysis will be performed using the SPSS platform.
Results
In this pilot study, 134 patients who underwent major cardiac surgery were enrolled. Of these 44 patients developed AKI as defined by KDIGO criteria( 22 Stage 1, 15 stage 2, and 7 stage 3). There was no statistical significance in the baseline characteristics when compared to age, gender, htn, ckd between patients with and without aki. Overhydration as measured by ECW/TBW ration of > 0.38 was significantly higher on day 2 and 5 in patients who developed AKI .(P<0.00, All 44 patients in aki versus 40 in the non aki group). The PBF, ICW, BMI nad overall BCM score was higher in patient with AKI ( p<0.00). 7 patients required RRT( 6 SLED and 1 Acute PD). There was 1 death in theAKI group. The mean duration of hospital stay was longer ( 14 +/- 5 vs 7 +/- 3.5 ) in the AKI grroup
Conclusion
There is not much data on BCM and fluid assessment in cardiac surgery patients. These patients have many risk factors and a failing heart and associated renal dysfunction in many makes it very difficult to guide volume therapy in these patients. Many of the so called standard objective measures in assessing volume are not fool- proof . This study will be one of the firsts from India to assess fluid status in these patients and help in guiding therapy and also knowing the outcomes of such an objective measurement
Acute Kidney Injury Post-cardiac Surgery in Infants and Children: A Single-Center Experience in a Developing Country
