Investigating the Effect of Near Infra-Red Spectroscopy (NIRS) on Early Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major adverse effect of cardiac surgery. The early detection of this complication can improve the quality of postoperative care and help prevent this phenomenon. Methods: In this prospective descriptive-analytical study, 148 patients were enrolled, 107 of whom were selected for analysis between February and September 2019 in the Cardiac Surgery Unit of Golestan Hospital, Ahvaz, Iran. Kidney tissue oxygen saturation was measured at multiple definite times during surgery. Hemoglobin, blood urea nitrogen, creatinine, and lactate were measured during and 48 hours after the surgery. Results: Forty-one patients were diagnosed with CSA-AKI according to the KDIGO criteria. Parametric and non-parametric analyses showed no significant difference between the CSA-AKI and non-CSA-AKI groups in the demographic parameters. Repeated measures ANOVA showed no significant difference in parameters, except for BUN. Repeated measures ANOVA showed a significant difference between both groups and time factors (P < 0.001, P = 0.0006, respectively). The ROC curve analyses showed that in a single point of time, the difference in the middle of CPB time from baseline had a high value in the prediction of AKI (AUC: 0.764; CI: 0.57 - 0.951). Conclusions: Kidney saturation monitoring could be considered in cardiac surgery for the rapid detection of CSA-AKI. Although kidney tissue saturation is not correlated directly to the arterial oxygen saturation, the physician and the surgery team can predict the chance of acute kidney injury.

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Investigating the Effect of Near Infra-red Spectroscopy (NIRS) on Early Diagnosis of Cardiac Surgery Associated Acute Kidney Injury

10.21203/rs.3.rs-78250/v1 ◽

2020 ◽

Author(s):

Fatemeh Javaherforoosh zadeh ◽

Hojatolah Bhandori ◽

Sara Jarirahmadi ◽

Nima Bakhtiari

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Single Point ◽

Kidney Tissue ◽

Kidney Injury ◽

Major Complication ◽

Repeated Measurement ◽

Tissue Oxygen Saturation ◽

Operative Care ◽

Significant Difference

Abstract Background. Cardiac surgery-associated acute kidney injury (CSA –AKI), is a major complication of cardiac surgery. Early detection of this complication can improve the quality of post-operative care and help to prevent this phenomenon.Materials and Methods: 148 patients were enrolled to study and 107 patients were selected for analysis between February and September 2019 in the cardiac surgery unit of Golestan Hospital. Ahvaz. Iran. Kidney tissue oxygen saturation was measured in multiple definite times during surgery. Hemoglobin, blood urea nitrogen, creatinine, and lactate were measured during and 48 hours after surgery.Results: Forty-one patients were diagnosed of CSA-AKI according to KDIGO criteria. Parametric and non-parametric analyzes significant difference was not detected between CSA-AKI and NON CSA-AKI group in the demographic parameter. Repeated measurement of ANOVA Analysis did not show any significant difference in parameters except for BUN. Repeated measurement of ANOVA showed a significant difference in both groups and time factors (p<0.001, p=0.0006 respectively). ROC curve analyzes showed in a single point of time, difference the middle of CPB time from baseline high-value in the prediction of AKI 0.764 (0.57 to 0.951) (AUC-CI). Conclusion; Kidney saturation monitoring could be considered as routine monitoring in cardiac surgery for the rapid detection of CSA -AKI. Although kidney tissue saturation is not correlated directly to the arterial saturation of oxygen, physician and surgery team could predict the chance of acute kidney injury exposure.

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Postoperative kidney oxygen saturation as a novel marker for acute kidney injury after adult cardiac surgery

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.09.115 ◽

2019 ◽

Vol 157 (6) ◽

pp. 2340-2351.e3 ◽

Cited By ~ 13

Author(s):

Christian Ortega-Loubon ◽

Manuel Fernández-Molina ◽

Inmaculada Fierro ◽

Pablo Jorge-Monjas ◽

Yolanda Carrascal ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Kidney Injury ◽

Adult Cardiac Surgery

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The Relevance of Renal Oxygen Saturation Over Other Markers in Cardiac Surgery–Associated Acute Kidney Injury

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.09.031 ◽

2019 ◽

Vol 33 (10) ◽

pp. 2622-2623 ◽

Cited By ~ 4

Author(s):

Christian Ortega-Loubon ◽

Manuel Fernández-Molina ◽

Pablo Jorge-Monjas ◽

Inmaculada Fierro ◽

Gonzalo Herrera-Calvo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Kidney Injury ◽

Renal Oxygen

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Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

Medicinski pregled ◽

10.2298/mpns2002005g ◽

2020 ◽

Vol 73 (1-2) ◽

pp. 5-12

Author(s):

Miodrag Golubovic ◽

Andrej Preveden ◽

Ranko Zdravkovic ◽

Jelena Vidovic ◽

Bojan Mihajlovic ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Uric Acid ◽

Cardiac Surgery ◽

Kidney Injury ◽

C Reactive Protein ◽

Reactive Protein ◽

Preoperative Hemoglobin ◽

Significant Difference ◽

Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Journal of International Medical Research ◽

10.1177/0300060517741064 ◽

2017 ◽

Vol 46 (3) ◽

pp. 1130-1137 ◽

Cited By ~ 3

Author(s):

Canan Balci ◽

Engin Haftaci ◽

Atike Tekeli Kunt

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Near Infrared ◽

Artery Bypass ◽

Kidney Injury ◽

Hemoglobin Concentration ◽

Cerebral Oximetry ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO2) measured intraoperatively and postoperatively in patients undergoing cardiac surgery. Methods We retrospectively analyzed the prospectively collected data of 45 adult patients with normal renal function who underwent isolated coronary artery bypass grafting (CABG) from January 2014 to May 2014. Kidney injury was assessed according to the Acute Kidney Injury Network criteria. rScO2 and hemoglobin were measured every hour intraoperatively and for the first 24 hours postoperatively. Results The hemoglobin concentration and rScO2 were significantly lower in patients with than without AKI, and no linear trends were observed. No exact cut-off values were obtained. Conclusion This retrospective study shows that a lower rScO2 and hemoglobin concentration are correlated with AKI after CABG in patients with no peripheral vascular disease or recent myocardial infarction. We suggest that cerebral oximetry alone may predict postoperative AKI well.

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Haptoglobin and Free Haemoglobin during Cardiac Surgery—is there a Link to Acute Kidney Injury?

Anaesthesia and Intensive Care ◽

10.1177/0310057x1704500109 ◽

2017 ◽

Vol 45 (1) ◽

pp. 58-66 ◽

Cited By ~ 7

Author(s):

A. J. Wetz ◽

E. M. Richardt ◽

H. Schotola ◽

M. Bauer ◽

A. Bräuer

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cell Injury ◽

Binding Capacity ◽

Kidney Injury ◽

Lower Baseline ◽

Significant Difference ◽

Moderate Negative Correlation ◽

Free Haemoglobin ◽

Low Levels

Acute kidney injury (AKI) is frequently observed after cardiac surgery (CS) with cardiopulmonary bypass (CPB). Multiple mechanisms underlie this phenomenon, including CPB-dependent haemolysis. Haemoglobin is released during haemolysis, and free haemoglobin (frHb) causes tubular cell injury after exceeding the binding capacity of haptoglobin (Hp). The objective of this study was to investigate the influence of perioperative changes in frHb and Hp levels on the incidence of CS-associated (CSA) AKI. After receiving local ethics committee approval and obtaining informed consent from our patients, we analysed the data pertaining to 154 patients undergoing CPB surgery. We recorded frHb and Hp concentrations pre-, intra- and postoperatively and defined AKI using the Kidney Disease Improving Global Outcomes (KDIGO) classification. We observed that frHb levels increased significantly during surgery and then decreased at ten hours thereafter and that Hp levels decreased during surgery and remained at low levels until the first postoperative day. We noted a moderate negative correlation between frHb and Hp levels. AKI was identified in 45.5% of patients; however, there was no significant difference in frHb or Hp levels between patients with and without AKI. We did not observe a relationship between frHb or Hp levels and CSA AKI and thus could not confirm the hypothesis that patients with higher baseline Hp concentrations experience a lower incidence of AKI than patients with lower baseline Hp concentrations.

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Comparison the Sedation Effect and Satisfaction of Two Combinations, Dexmedetomidine and Fentanyl with Midazolam and Fentanyl, in Patients Undergoing Bronchoscopy

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v6i6.856 ◽

2021 ◽

Vol 6 (6) ◽

Author(s):

Alireza Kamali ◽

Sepideh Sarkhosh ◽

Hosein Kazemizadeh

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Oxygen Saturation ◽

Statistical Tests ◽

Arterial Oxygen Saturation ◽

Mean Blood Pressure ◽

Arterial Oxygen ◽

P Value ◽

Double Blind ◽

Significant Difference

Objectives: The aim of this study was to compare sedative effects of dexmedetomidine and fentanyl with midazolam and fentanyl in patients undergoing bronchoscopy. Methods: This study was a double-blind randomized clinical trial that was performed on 92 patients who referred to Amir al Momenin Hospital in Arak for bronchoscopy and underwent ASA 1 or 2 underlying grading procedure. Patients were randomly divided into two groups of dexmedetomidine and fentanyl (D) midazolam and fentanyl (M). Primary vital signs including hypertension and arterial oxygen saturation were monitored and recorded. Then all patients were injected with 2 μg / kg fentanyl as a painkiller and after 3 minutes 30 μg dexmedetomidine in syringe with code A and midazolam 3 mg in syringe with code B were injected to patients by an anesthesiologist. Then the two groups were compared in terms of pain at injection, conscious relaxation, satisfaction of operation, recovery time, hypotension and arterial oxygen saturation and drug side effects and data were analyzed by using statistical tests. Results: There was no significant difference between the two groups in terms of mean age and sex distribution. According to the results of this study, there was no significant difference between the two groups in mean blood pressure (P-value = 0.6) and mean heart rate (P-value = 0.4) at the time of bronchoscopy, but at 5 and 10 minutes after bronchoscopy there was a significant difference, mean blood pressure and heart rate were significantly lower in dexmedetomidine group. Conclusion: Both dexmedetomidine and midazolam drug groups contributed to the development of stable and sedative hemodynamics and satisfaction in patients undergoing bronchoscopy, however, the dexmedetomidine and fentanyl group showed a significant decrease in blood pressure and heart rate compared to midazolam and fentanyl and a weaker decrease in arterial oxygen saturation, and patients with bronchoscopy were more satisfied in the dexmedetomidine group.

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Analysis of the Relationship Between Preoperative Arterial Oxygen Partial Pressure and Acute Kidney Injury after Surgery for Tetralogy of Fallot and Explore the Related Risk Factors

10.21203/rs.3.rs-154463/v1 ◽

2021 ◽

Author(s):

Yaya Xu ◽

Xiaodong Zhu ◽

Lili Xu ◽

Zhen Li ◽

Lulu Cao ◽

...

Keyword(s):

Acute Kidney Injury ◽

Oxygen Partial Pressure ◽

Partial Pressure ◽

Tetralogy Of Fallot ◽

Kidney Injury ◽

Oxygen Metabolism ◽

Arterial Oxygen ◽

Related Risk ◽

Retrospective Clinical Study ◽

Significant Difference

Abstract Background: Acute kidney injury (AKI) is a severe complication of pediatric cardiothoracic surgery (CTS). It is debatable whether patients with the low preoperative arterial partial pressure of oxygen (PaO2) are more likely to develop AKI after surgery. The study aims to investigate the incidence and possible influencing factors of AKI in patients undergoning the radical operation of tetralogy of Fallot (TOF) with different preoperative oxygen partial pressure. Methods: In this retrospective clinical study, 36 pediatric patients who underwent CTS were enrolled in this study. The patients were divided into 4 groups according to preoperative PaO2. We examined the baseline data and outcomes of the study population among groups.Results: Of the 36 patients, 17 developed AKI. Compared with the high preoperative PaO2 group, the low preoperative PaO2 group mostly had severe AKI and persistent, but there was no significant difference in AKI among groups (P＞0.05). In the 48-hour continuous monitoring after surgery, the oxygen metabolism indexes (Pv-aCO2/Ca-vO2) were correlated with AKI and there were significant differences among the groups. Conclusions: Low preoperative PaO2 does not significantly increase the incidence of AKI and Pv-aCO2/Ca-vO2 is associated with postoperative AKI and persistent.

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Comparison of Intra and Post-operative Sedation efficacy of Dexmedetomidine-Midazolam and Dexmedetomidine-Propofol for Major Abdominal Surgery

Current Drug Metabolism ◽

10.2174/1389200222666211103121832 ◽

2021 ◽

Vol 22 ◽

Author(s):

Yuanyuan Gao ◽

Fei Yan

Keyword(s):

Clinical Trial ◽

Abdominal Surgery ◽

Oxygen Saturation ◽

General Anesthesia ◽

Arterial Oxygen Saturation ◽

Carbon Dioxide Tension ◽

Major Abdominal Surgery ◽

Arterial Oxygen ◽

Anesthesia Induction ◽

Significant Difference

Background: The effectiveness and side effects of dexmedetomidine (DEX) in combination with midazolam and propofol have not been comparatively studied in a single clinical trial as sedative agents to general anesthesia before. Objective: The objective of this study is to compare intra and post-operative sedation between DEX-Midazolam and DEX-Propofol in patients who underwent major abdominal surgery on the duration of general anesthesia, hemodynamic and sedation effect. Method: This prospective, randomized, double-blinded clinical trial included 50 patients who were 20 to 60 years of age and admitted for major abdominal surgery. The patients were randomly assigned by a computer-generated random numbers table to sedation with DEX plus midazolam (DM group) (n=25) or DEX plus propofol (DP group) (n=25). In the DM group, patients received a bolus dose of 0.1 mg/kg of midazolam and immediately initiated the intravenous (i.v.) infusion of DEX 1 µg/kg over a 10 min and 0.5 µg/kg/hr by continuous i.v. infusion within operation period. In the DP group, patients received pre-anesthetic i.v. DEX 1 µg/kg over 15 min before anesthesia induction and 0.2-1 µg/kg/hr by continuous i.v. infusion during the operative period. After preoxygenation for at least 2 min, during the surgery, patients received propofol infusion dose of 250 μg/kg/min for 15 min then a basal infusion dose of 50 μg/kg/min. The bispectral index (BIS) value, as well as mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), percutaneous arterial oxygen saturation (SpO2) and end-tidal carbon dioxide tension (ETCO2) were recorded before anesthesia (T0), during anesthesia (at 15-min intervals throughout the surgical procedure), by a blinded observer. Evidence of apnea, hypotension, hypertension and hypoxemia were recorded during surgery. Results: The hemodynamic changes, including HR, MAP, BIS, VT, SaO2, and RR had a downward tendency with time, but no significant difference was observed between the groups (P>0.05). However, the two groups showed no significant differences in ETCO2 and SPO2 values in any of the assessed interval (P>0.05). In this study, the two groups showed no significant differences in the incidence of nausea, vomiting, coughing, apnea, hypotension, hypertension, bradycardia and hypoxemia (P>0.05). Respiratory depression and Conclusion: Our study showed no significant differences between the groups in hemodynamic and respiratory changes in each of the time intervals. There were also no significant differences between the two groups in the incidence of complication intra and post-operative. Further investigations are required to specify the optimum doses of using drugs which provide safety in cardiovascular and respiratory system without adverse disturbance during surgery.

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Variation in clinical usefulness of biomarkers of acute kidney injury in young children undergoing cardiac surgery

Clinical and Experimental Pediatrics ◽

10.3345/cep.2019.00913 ◽

2020 ◽

Vol 63 (4) ◽

pp. 151-156

Author(s):

Hee Sun Baek ◽

Youngok Lee ◽

Hea Min Jang ◽

Joonyong Cho ◽

Myung Chul Hyun ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Young Children ◽

Serum Creatinine ◽

Congenital Heart ◽

Heart Diseases ◽

Kidney Injury ◽

Clinical Usefulness ◽

Congenital Heart Diseases ◽

Significant Difference

Background: Acute kidney injury (AKI) is one of the most significant postoperative complications of pediatric cardiac surgery. Because serum creatinine has limitations as a diagnostic marker of AKI, new biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are being evaluated to overcome these limitations and detect AKI at an early stage after cardiac surgery.Purpose: This study aimed to investigate the clinical usefulness of these biomarkers in young children.Methods: Thirty patients with congenital heart diseases who underwent cardiac surgery using cardiopulmonary bypass (CPB) were selected, and their urine and blood samples were collected at baseline and 6, 24, and 48 hours after surgery. Serum creatinine and blood urea nitrogen levels as well as NGAL, KIM-1, and IL-18 levels in urine samples were measured, and clinical parameters were evaluated.Results: Of the 30 patients, 12 developed AKI within 48 hours after cardiac surgery. In the AKI group, 8 of 12 (66.6%) met AKI criteria after 24 hours, and urine KIM-1/creatinine (Cr) level (with adjustment of urine creatinine) peaked at 24 hours with significant difference from baseline level. Additionally, urine KIM-1/Cr level in the AKI group was significantly higher than in the non-AKI group at 6 hours. However, urine NGAL/Cr and IL-18/Cr levels showed no specific trend with time for 48 hours after cardiac surgery.Conclusion: It is suggested that urine KIM-1/Cr concentration could be considered a good biomarker for early AKI prediction after open cardiac surgery using CPB in young children with congenital heart diseases.

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