Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure

Gold, Jeffrey P.; Charlson, Mary E.; Williams-Russo, Pamela; Szatrowski, Ted P.; Peterson, Janey C.; Pirraglia, Paul A.; Hartman, Gregg S.; Yao, Fun Sun F.; Hollenberg, James P.; Barbut, Denise; Hayes, Joseph G.; Thomas, Stephen J.; Purcell, M. H.; Mattis, Steven; Gorkin, Larry; Post, Martin R.; Krieger, Karl H.; Isom, O. Wayne

doi:10.1016/s0022-5223(95)70053-6

Cited by 404 publications

(226 citation statements)

References 30 publications

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“…Gold et al have shown a reduction in neurologic and cardiac morbidity when mean perfusion pressures were empirically maintained above 80mmhg. 18 This study appears to confirm that maintaining higher perfusion pressures during cardiopulmonary bypass is an adjunctive strategy to reduce organ injury and resource utilization.…”

Section: Discussionsupporting

confidence: 58%

Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

Kim

Arnaoutakis

Martin

et al. 2008

Journal of the American College of Surgeons

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Background-Patients undergoing complex cardiac surgery (thoracic aorta and valve) are at risk for organ failure and increased resource utilization. Neutrophil gelatinase-associated lipocalin (NGAL) has been found to be an early biomarker for renal injury. Multiplex cytokine immunoassays allow the evaluation of the early inflammatory response. We examined the relationship between early biomarker appearance (NGAL and multiplex cytokines) and organ injury and resource utilization.

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Section: Discussionsupporting

confidence: 58%

Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

Kim

Arnaoutakis

Martin

et al. 2008

Journal of the American College of Surgeons

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“…Maximal renal blood flow on cardiopulmonary bypass is approximately 55% of prebypass flow (123). On the basis of two small studies, it seems that higher perfusion pressures may improve renal function during cardiopulmonary bypass but do not affect postoperative function (120,124). The existence of CKD as well as chronic hypertension may affect the ideal mean arterial pressure, because renal injury seems to be accompanied by a loss of autoregulation (125,126).…”

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

258

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…It is well known that older patients and those with hypertension and diabetes may be at increased risk of hypoperfusion events owing to their lack of adequate autoregulatory mechanisms within the cerebral circulation [10]. Moreover, the ideal level of arterial blood pressure during CPB remains a debatable topic, and the few existing studies have not resulted in definitive conclusions about optimal blood pressure management [27,28].…”

Section: Commentmentioning

confidence: 99%

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Lisle¹,

Barrett²,

Gazoni³

et al. 2008

The Annals of Thoracic Surgery

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Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure

Abstract: Higher mean arterial pressures during cardiopulmonary bypass can be achieved in a technically safe manner and effectively improve outcomes after coronary bypass.

Cited by 404 publications

References 30 publications

Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

Early blood biomarkers predict organ injury and resource utilization following complex cardiac surgery

AKI Associated with Cardiac Surgery

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

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