Intraoperative Urinary Output Does Not Predict Postoperative Renal Function in Patients Undergoing Abdominal Aortic Revascularization

Alpert, Ricki A.; Roizen, Michael F.; Hamilton, William K.; Storey, R. J.; Ehrenfeld, William K.; Poler, S. Mark; Wylie, Edwin J.

doi:10.1097/00132586-198504000-00041

Cited by 35 publications

(45 citation statements)

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“…Alpert et al [21] reported that intraoperative urine output did not predict postoperative renal failure. Our data suggest further that intraoperative urine output may also not predict intraoperative renal function.…”

Section: Discussionmentioning

confidence: 99%

Influence of Mannitol and Dopamine on Renal Function during Elective Infrarenal Aortic Clamping in Man

Paul¹,

Mazer²,

Byrick³

et al. 1986

Am J Nephrol

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The impact of elective infrarenal aortic clamping on parameters of renal function was evaluated in 27 extracellular fluid volume expanded patients. Significant transient decreases (p < 0.05) in glomerular filtration rate were observed in all three groups either in the early or late post-clamp release period, despite maintenance of hemo-dynamic stability. This study documents transient decreases in glomerular filtration rate which occurred following release of the infrarenal aortic cross-clamp. No clinically important benefit from the use of mannitol and dopamine over extracellular fluid volume expansion with saline alone was demonstrated in the prevention of the changes in renal function associated with aortic cross-clamping.

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Section: Discussionmentioning

confidence: 99%

Influence of Mannitol and Dopamine on Renal Function during Elective Infrarenal Aortic Clamping in Man

Paul¹,

Mazer²,

Byrick³

et al. 1986

Am J Nephrol

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“…The role of intraoperative urine output as a predictor for postoperative AKI is controversial, with several studies of patients not undergoing cardiac surgery showing no relationship between intraoperative urine output and postoperative kidney function (85,86). Reduced urine output is widely considered to be a part of the stress response to surgery, and the predictive use of intraoperative urine output in patients undergoing cardiac surgery has not been firmly established.…”

Section: Urine Outputmentioning

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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“…77,78 Over 20 years ago, two studies showed that intraoperative urinary output was not predictive of postoperative renal insufficiency in patients undergoing aortic reconstruction. 79,80 Recently, in an observational study of over 65,000 patients undergoing noncardiac surgery, intraoperative oliguria, defined as UOP \ 0.5 mLÁkg -1 Áhr -1 , was not associated with renal failure. 39 Conversely, as well as other detrimental effects, such as GI function, positive fluid balance has been shown to be associated with in increased incidence of acute kidney injury (AKI) after major surgery.…”

Section: Low Perioperative Uopmentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

230

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Intraoperative Urinary Output Does Not Predict Postoperative Renal Function in Patients Undergoing Abdominal Aortic Revascularization

Cited by 35 publications

References 0 publications

Influence of Mannitol and Dopamine on Renal Function during Elective Infrarenal Aortic Clamping in Man

Influence of Mannitol and Dopamine on Renal Function during Elective Infrarenal Aortic Clamping in Man

AKI Associated with Cardiac Surgery

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

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