Effects of Mild Hypothermia and Rewarming on Renal Function After Coronary Artery Bypass Grafting

Boodhwani, Munir; Rubens, Fraser D.; Wozny, Denise; Nathan, Howard J.

doi:10.1016/j.athoracsur.2008.10.078

Cited by 86 publications

(77 citation statements)

References 29 publications

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“…The most important factor is the balance between oxygen delivery and oxygen consumption which is crucial everywhere in the body, not least in the kidney which is more susceptible to ischemia [24] . Even the probable risk of hypothermia during CPB may be explained by reperfusion ischemia due to rapid rewarming [115] . That hemodilution has some adverse effects does not mean that blood transfusion is absolutely beneficial in improving renal function.…”

Section: Hemodilutionmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

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Section: Hemodilutionmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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“…Исследование у 300 пациентов, рандомизированных на нормо-или гипотермическое ИК, не выявило разницы в послеоперационном клиренсе креати-нина [106]. В двух малых исследованиях функция тромбоцитов достоверно ухудшалась больше у па-циентов с гипотермией [12,13]. А фибринолитиче-ская активность была выше в группе больных с бо-лее высокой температурой [31].…”

unclassified

Physiological Parameters of Artificial Blood Circulation From the Position of the Evidence Based Medicine (Part 2)

Kornilov¹,

Пономарев²,

Shmyrev³

et al. 2016

MAaR

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1ФГБУ «Новосибирский НИИ патологии кровообращения им. акад. Е. Н. Мешалкина» МЗ РФ, г. Новосибирск 2 ГБУЗ «НИИ -краевая клиническая больница № 1 им. проф. С. В. Очаповского», г. Краснодар 3 ФГБУ «Федеральный центр сердечно-сосудистой хирургии», г. Пермь В обзоре продолжено рассмотрение аспектов управления основными физиологическими параметрами во время искусственного крово-обращения у взрослых пациентов с позиции доказательной медицины, начатое в предыдущем номере журнала. Данная часть посвящена управлению температурой, доставкой кислорода и пульсацией. Делается заключение, что в настоящее время большинство рекомендаций по проведению искусственного кровообращения не имеют серьезной доказательной базы. Для достижения наилучших клинических результатов предложено отслеживать публикуемые данные и соотносить их с собственным опытом с учетом соотношения польза/риск. Показано, что в основе большинства осложнений, связанных с искусственным кровообращением, лежат разные причины, и это диктует необходимость мультидисциплинарного подхода к их предотвращению. This review continues to investigate the management aspects of main physiological parameters during artificial blood circulation in the adult patients from the position of the evidence based medicine, and the first part of this review was published in the previous issue. This part is devoted to management of temperature, oxygen delivery and pulsation. The authors conclude that currently the majority of recommendations for artificial blood circulation are not based on the relevant evidences. In order to achieve best clinical results it has been offered to review the published data and relate them with the personal experience evaluating benefits and risks. It has been shown that the majority of complications related to artificial blood circulation have various causes and it demands the multi-disciplinary approach to their prevention.

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“…Cardiac surgery induces a rapid and potent increase in circulating levels of proinflammatory cytokines such as IL-6 and TNF-a). 9,15,16 These proinflammatory cytokines promote adherence of inflammatory cells to activated endothelium in the peritubular capillaries of the outer medulla, ultimately resulting in medullary congestion and hypoxic injury to the proximal. 17,18 Glucocorticoids are likely to interfere with this process through direct transcriptional regulation of target genes, including upregulation of anti-inflammatory cytokines such as lipocortin 1 and downregulation of proinflammatory cytokines through inhibition of NFkB.…”

mentioning

confidence: 99%

“…[6][7][8] Cardiac surgery results in a postoperative systemic inflammatory response syndrome due to a variety of factors including surgical trauma, exposure of blood to the artificial surface of the bypass circuit, tissue hypoperfusion, hemolysis, hemodilution, blood transfusion, and hypothermia. [9][10][11][12] Inflammation is believed to play a key role in the pathophysiology of AKI after cardiac surgery with CPB. A number of proinflammatory pathways are activated during CPB and can lead to leukocyte extravasation, lipid peroxidation, renal medullary congestion, and tubular cell injury.…”

mentioning

confidence: 99%

“…A number of proinflammatory pathways are activated during CPB and can lead to leukocyte extravasation, lipid peroxidation, renal medullary congestion, and tubular cell injury. 1,9 Multiple strategies have been proposed to attenuate the inflammatory response after cardiac surgery with CPB, including the use of glucocorticoids. To date, the effect of glucocorticoids on AKI after cardiac surgery has been evaluated as a primary outcome in 14 randomized controlled trials, the largest of which included 216 patients.…”

mentioning

confidence: 99%

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Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

Jacob

Leaf

Dieleman³

et al. 2015

Journal of the American Society of Nephrology

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Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR,15 ml/min per 1.73 m 2 . In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD. 26: 294726: -295126: , 201526: . doi: 10.1681 Acute kidney injury is one of the most ominous complications after cardiac surgery with cardiopulmonary bypass (CPB). Approximately 1% of patients undergoing cardiac surgery require RRT for severe postoperative AKI, and experience strikingly high in-hospital mortality rates exceeding 40%. 1-3 Less severe AKI is far more common and identifies patients still at increased risk of shortand long-term mortality, prolonged length of hospital stay, and higher hospital costs. 4,5 The pathogenesis of AKI after cardiac surgery is complex and includes patient-related factors such as age and comorbidities (e.g., CKD and diabetes mellitus) as well as surgical factors such as type of procedure and duration of CPB. [6][7][8] Cardiac surgery results in a postoperative systemic inflammatory response syndrome due to a variety of factors including surgical trauma, exposure of blood to the artificial surface of the bypass circuit, tissue hypoperfusion, hemolysis, hemodilution, blood transfusion, and hypothermia. 9-12 Inflammation is believed to play a key role in the pathophysiology of AKI after cardiac surgery with CPB. A number of proinflammatory pathways are activated during CPB and can lead to leukocyte extravasation, lipid peroxidation, renal medullary congestion, and tubular cell injury. 1,9 Multiple strategies have been proposed to attenuate the inflammatory response after cardiac surgery with CPB, including the use of glucocorticoids. To date, the effect of glucocorticoids on AKI after cardiac surgery has been evaluated as a primary outcome in 14 randomized controlled trials, the largest of which included 216 patients. 3 A meta-analysis of these studies (which included a total of 888 patients) concluded that glucocorticoids have no protective effect on AKI after cardiac surgery. 3 However, these studies were underpowered, particularly to detect severe AKI. J Am Soc NephrolWe therefore conducted a post hoc analysis of severe AKI in the Dexamethasone for Cardiac Surgery (DE...

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Effects of Mild Hypothermia and Rewarming on Renal Function After Coronary Artery Bypass Grafting

Cited by 86 publications

References 29 publications

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Physiological Parameters of Artificial Blood Circulation From the Position of the Evidence Based Medicine (Part 2)

Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

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