Glycemia Control  Pada Pasien Paska Pembedahan Jantung: Studi Kasus

ABSTRAKCardiac surgery-associated acute kidney injury (CSA-AKI) merupakan komplikasi utama dari pembedahan jantung. Salah satu kondisi yang dapat menyebabkan terjadinya CSA-AKI pada pasien bedah jantung adalah ketidakstabilan kadar glukosa darah. Protokol Enhanced Recovery After Surgery (ERAS) memaparkan pentingnya glycemia control untuk mencegah komplikasi terjadinya CSA-AKI. Artikel ini merupakan studi kasus yang menggambarkan manajemen keperawatan : glycemic control untuk mencegah terjadinya CSA-AKI pada pasien bedah jantung. Setelah dilakukan intervensi keperawatan berupa glycemia control, pasien tidak mengalami CSA-AKI. Manajemen gula darah pada melalui manajemen diet dan kolaborasi manajemen insulin merupakan rekomendasi ERAS dalam mencegah CSA-AKI pada pasien pembedahan jantung. ABSTRACTCardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication of heart surgery. One of the conditions that can cause CSA-AKI in cardiac surgery patients is the instability of blood glucose levels. The Enhanced Recovery After Surgery (ERAS) protocol explains the importance of glycemic control to prevent complications from CSA-AKI. This article is a case study describing nursing management: glycemic control to prevent CSA-AKI in cardiac surgery patients. After the nursing intervention in the form of glycemia control, the patient did not experience CSA-AKI. Blood sugar management through diet management and insulin management collaboration is ERAS recommendations in preventing CSA-AKI in cardiac surgery patients.

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Acute kidney injury in Enhanced Recovery After Surgery (ERAS) protocols in open gynecologic oncology surgery

Gynecologic Oncology ◽

10.1016/s0090-8258(21)00793-9 ◽

2021 ◽

Vol 162 ◽

pp. S81

Author(s):

Matthew Cowan ◽

Hooman Azad ◽

Brad Nakamura ◽

Shireen Ahmad ◽

Anna Strohl

Keyword(s):

Acute Kidney Injury ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Oncology ◽

Kidney Injury

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Caution: Increased Acute Kidney Injury in Enhanced Recovery after Surgery (ERAS) Protocols

The American Surgeon ◽

10.1177/000313481908500221 ◽

2019 ◽

Vol 85 (2) ◽

pp. 156-161 ◽

Cited By ~ 2

Author(s):

Crystal P. Koerner ◽

Alexandra G. Lopez-Aguiar ◽

Mohammad Zaidi ◽

Shelby Speegle ◽

Glen Balch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Kidney Injury ◽

Morbidity And Mortality ◽

Elective Colorectal Surgery ◽

Baseline Serum ◽

Increased Risk ◽

Postoperative Aki

Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P = 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3–9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6–16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5–5.8; P < 0.01). On multi-variable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5–7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P = 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.

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PD60-07 ACUTE KIDNEY INJURY WITH ENHANCED RECOVERY AFTER SURGERY PROTOCOL IN RADICAL CYSTECTOMY SURGERY

The Journal of Urology ◽

10.1097/ju.0000000000000977.07 ◽

2020 ◽

Vol 203 ◽

pp. e1276-e1277

Author(s):

Peter Hanna* ◽

Matthew Peterson ◽

Arveen Kalapera ◽

Subodh Regmi ◽

Kalyana Srujana ◽

...

Keyword(s):

Acute Kidney Injury ◽

Radical Cystectomy ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Kidney Injury

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Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery

PLoS ONE ◽

10.1371/journal.pone.0252209 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252209

Author(s):

Giuseppe Filiberto Serraino ◽

Michele Provenzano ◽

Federica Jiritano ◽

Ashour Michael ◽

Nicola Ielapi ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Cardiac Surgery ◽

Blood Glucose ◽

Kidney Injury ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Risk Patients

Background Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22–57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation. Methods We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model. Results We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality. Conclusions AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.

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Incidence of acute kidney injury after open gynecologic surgery in an enhanced recovery after surgery pathway

Gynecologic Oncology ◽

10.1016/j.ygyno.2021.08.006 ◽

2021 ◽

Author(s):

Sarah P. Huepenbecker ◽

Maria D. Iniesta ◽

Andrés Zorrilla-Vaca ◽

Pedro T. Ramirez ◽

Katherine E. Cain ◽

...

Keyword(s):

Acute Kidney Injury ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Kidney Injury ◽

Gynecologic Surgery

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Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951116002067 ◽

2016 ◽

Vol 27 (6) ◽

pp. 1068-1075 ◽

Cited By ~ 10

Author(s):

David M. Kwiatkowski ◽

Elizabeth Price ◽

David M. Axelrod ◽

Anitra W. Romfh ◽

Brian S. Han ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Heart Surgery ◽

Kidney Injury ◽

Congenital Heart Surgery ◽

Left Ventricular

AbstractBackgroundAcute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.MethodsThis single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.ResultsData from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.ConclusionsWe demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.

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