scholarly journals Goal Directed Perfusion: Bibliographical Review

2019 ◽  
pp. 5-11 ◽  
Author(s):  
Juan Carlos Santos ◽  
Jose Maria Jaime ◽  
Jose Maria Gonzalez
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Extracorporeal Circulation ◽  
Kidney Injury ◽  
Carbon Dioxide Production ◽  
Search Term ◽  
Initial Term ◽  
Venous Oxygen Saturation ◽  
Pubmed Search ◽  
Made In

Objective: The aim of this study is to synthesize the existing evidence on Goal Directed Perfusion Methods: The search for the existing evidence was made in the MEDLINE databases, using the PubMed search engine. The initial search term was “goal directed perfusion.” In order to narrow the search, MeHS terms such as “cardiac surgery” and “cardiopulmonary bypass” were used together with the initial term and the Boolean operator AND. Results: At first, 238 references were obtained, combined whit “cardiac surgery” there were 49 references and finally whit “cardiopulmonary bypass” 21. We read 23 articles. Levels of oxygen delivery (DO2i) > 272 ml/min/m2, minimize hemodilution an maintain hematocrit values > 26% decrease acute kidney injury. A carbon dioxide production VCO2 i > of 60 ml/min/m2 and DO2i/VCO2i < 5 are predictors of hyperlactatemia. The mixed venous oxygen saturation (SvO2) and the oxygen extraction rate (ERO2) are better predictors of transfusion during extracorporeal circulation than hemoglobin value. The majority of the bibliography refers to adult surgery, but the application of GDP to the pediatric perfusion is beginning. Conclusion: The improvement of “optimal” perfusion, considered the gold standard, towards goal directed perfusion is already in use. Many hospitals are incorporating online monitoring of the new perfusion parameters in order to apply a specific perfusion to each patient as well as his metabolic needs during extracorporeal circulation.

scholarly journals Optimal perfusion: Review based on recent scientific evidence

2019 ◽  
pp. 13-27
Author(s):  
Alexis Martin ◽  
Carlos Albendea ◽  
Jimmy Franklin Alemán ◽  
Victor Gómez ◽  
Laura Ciuró
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Circulation ◽  
Scientific Evidence ◽  
Kidney Injury ◽  
Physiological Variables ◽  
Analysis And Synthesis ◽  
Pubmed Search ◽  
Bibliographic Search ◽  
Risk Patients ◽  
History Of

Introduction: Throughout the history of extracorporeal circulation there have been several controversial aspects regarding the management of the different physiological, hemodynamic and technical variables. In this review we will synthesize recent scientific evidence of what we call "optimal perfusion". Method: The bibliographic search was carried out in the Cochrane and MEDLINE databases using the PubMed search engine, where the main term was “optimal perfusion” combining it with MeHS terms such as “cardiopulmonary bypass”, “cardiac surgery”, “acute kidney injury” and “goal directed perfusion”. Results: 168 references were obtained, of which 61 were selected for later analysis and synthesis. The main blood pressure remains one of the parameters with less consensus, especially in high-risk patients. The incidence of acute renal failure after cardiac surgery associated with extracorporeal circulation has undergone a notable change thanks to the management of physiological variables or the so-called goal directed perfusion. With these strategies it has been possible to update and review the critical hematocrit in order to ensure a constant and optimal oxygen supply at all times and avoid tissue hypoperfusion and its incidence in global morbidity. Conclusions: The parameters referred to as "optimal" are under continuous review and analysis and, together with the advances in active and real-time monitoring of the delivery and consumption parameters, have changed management in our daily clinical practice.

scholarly journals Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kota Saito ◽  
Sho Ohno ◽  
Makishi Maeda ◽  
Naoyuki Hirata ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Maze Procedure ◽  
Intraoperative Awareness ◽  
Case Presentation ◽  
Venous Oxygen Saturation ◽  
Index Value

Abstract Background Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB. Case presentation A 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

FC 051PREDICTIVE VALUE OF PLASMA NGAL:HEPCIDIN-25 FOR MAJOR ADVERSE KIDNEY EVENTS AFTER CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: A PILOT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Saban Elitok ◽  
Anja Haase-Fielitz ◽  
Martin Ernst ◽  
Michael Haase
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Roc Curve ◽  
Predictive Value ◽  
Kidney Injury ◽  
Urinary Output ◽  
Icu Admission ◽  
Plasma Ngal ◽  
Net Reclassification Improvement ◽  
Major Adverse Kidney Events

Abstract Background and Aims Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin-25 appear to be involved in catalytic iron-related kidney injury after cardiac surgery with cardiopulmonary bypass. We aimed to explore the predictive value of plasma NGAL, plasma hepcidin-25, and the plasma NGAL:hepcidin-25 ratio for major adverse kidney events after cardiac surgery. Method We compared the predictive value of plasma NGAL, hepcidin-25, and NGAL:hepcidin-25 with those of serum creatinine (Cr), and urinary output and urinary protein for primary endpoint major adverse kidney events (MAKE; acute kidney injury [AKI] stages 2 and 3, persistent AKI &gt; 48 hrs, acute dialysis, and in-hospital mortality) and secondary-endpoint AKI in 100 cardiac surgery patients at intensive care unit (ICU) admission. We performed ROC curve, logistic regression, and reclassification analyses. Results At ICU admission, plasma NGAL, plasma NGAL:hepcidin-25, and Cr predicted MAKE (area under the ROC curve [AUC]: 0.77 [95% confidence interval (CI) 0.60–0.94], 0.79 [0.63–0.95], 0.74 [0.51–0.97]) and AKI (0.73 [0.53–0.93], 0.89 [0.81–0.98], 0.70 [0.48–0.93]). For AKI prediction, NGAL:hepcidin-25 had a higher discriminatory power than Cr (AUC difference 0.26 [95% CI 0.00–0.53]). Urinary output and protein, plasma lactate, C-reactive protein, creatine kinase myocardial band, and brain natriuretic peptide did not predict MAKE or AKI (AUC &lt; 0.70). Only plasma NGAL:hepcidin-25 correctly reclassified patients for MAKE or AKI (category-free net reclassification improvement: 0.82 [95% CI 0.12–1.52], 1.03 [0.29–1.77]). After adjustment to the Cleveland risk score, plasma NGAL:hepcidin-25 ≥ 0.9 independently predicted MAKE (adjusted odds ratio 16.34 [95% CI 1.77–150.49], P = 0.014), whereas Cr did not. Conclusion NGAL:hepcidin-25 is a promising plasma marker for predicting postoperative MAKE.

CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

2021 ◽  
Author(s):  
Wenyan Liu ◽  
Yang Yan ◽  
Dan Han ◽  
Yongxin Li ◽  
Qian Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Rna Binding ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Proinflammatory Response ◽  
Increased Risk ◽  
Before And After ◽  
The Difference

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 138-144
Author(s):  
Helena Argiriadou ◽  
Polychronis Antonitsis ◽  
Anna Gkiouliava ◽  
Evangelia Papapostolou ◽  
Apostolos Deliopoulos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Correlation Coefficient ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Minimal Invasive ◽  
Elective Cardiac Surgery ◽  
Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

scholarly journals Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery

2020 ◽  
Vol 10 (5) ◽  
pp. 340-352
Author(s):  
Faeq Husain-Syed ◽  
Maria Giovanna Quattrone ◽  
Fiorenza Ferrari ◽  
Pércia Bezerra ◽  
Salvador Lopez-Giacoman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cardiac Surgery ◽  
Minimally Invasive Surgery ◽  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Baseline Serum

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. Objectives: We aimed to identify potentially modifiable risk factors for CSA-AKI. Methods: This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.

Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis?

2011 ◽  
Vol 16 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Elena Mancini ◽  
Fabio Caramelli ◽  
Marco Ranucci ◽  
Diego Sangiorgi ◽  
Letizia Bacchi Reggiani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Injury

Identification of Plasma Metabolites Prognostic of Acute Kidney Injury after Cardiac Surgery with Cardiopulmonary Bypass

2015 ◽  
Vol 14 (7) ◽  
pp. 2897-2905 ◽  
Author(s):  
Helena U. Zacharias ◽  
Jochen Hochrein ◽  
Franziska C. Vogl ◽  
Gunnar Schley ◽  
Friederike Mayer ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Injury ◽  
Plasma Metabolites
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