$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?

Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	de Somer, Filip [verfasserIn] Mulholland, John W Bryan, Megan R Aloisio, Tommaso Van Nooten, Guido J Ranucci, Marco

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2011

Schlagwörter:	Acute Kidney Injury Pump Flow Acute Kidney Injury Stage Postoperative Renal Function Negative Predictive Power

Anmerkung:	© de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (

Übergeordnetes Werk:	Enthalten in: Critical care - London : BioMed Central, 1997, 15(2011), 4 vom: 10. Aug.
Übergeordnetes Werk:	volume:15 ; year:2011 ; number:4 ; day:10 ; month:08

Links:	Volltext

DOI / URN:	10.1186/cc10349

Katalog-ID:	SPR02983077X

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520			\|a Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI.
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allfields	10.1186/cc10349 doi (DE-627)SPR02983077X (SPR)cc10349-e DE-627 ger DE-627 rakwb eng de Somer, Filip verfasserin aut $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213 Mulholland, John W aut Bryan, Megan R aut Aloisio, Tommaso aut Van Nooten, Guido J aut Ranucci, Marco aut Enthalten in Critical care London : BioMed Central, 1997 15(2011), 4 vom: 10. Aug. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:15 year:2011 number:4 day:10 month:08 https://dx.doi.org/10.1186/cc10349 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2011 4 10 08
spelling	10.1186/cc10349 doi (DE-627)SPR02983077X (SPR)cc10349-e DE-627 ger DE-627 rakwb eng de Somer, Filip verfasserin aut $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213 Mulholland, John W aut Bryan, Megan R aut Aloisio, Tommaso aut Van Nooten, Guido J aut Ranucci, Marco aut Enthalten in Critical care London : BioMed Central, 1997 15(2011), 4 vom: 10. Aug. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:15 year:2011 number:4 day:10 month:08 https://dx.doi.org/10.1186/cc10349 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2011 4 10 08
allfields_unstemmed	10.1186/cc10349 doi (DE-627)SPR02983077X (SPR)cc10349-e DE-627 ger DE-627 rakwb eng de Somer, Filip verfasserin aut $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213 Mulholland, John W aut Bryan, Megan R aut Aloisio, Tommaso aut Van Nooten, Guido J aut Ranucci, Marco aut Enthalten in Critical care London : BioMed Central, 1997 15(2011), 4 vom: 10. Aug. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:15 year:2011 number:4 day:10 month:08 https://dx.doi.org/10.1186/cc10349 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2011 4 10 08
allfieldsGer	10.1186/cc10349 doi (DE-627)SPR02983077X (SPR)cc10349-e DE-627 ger DE-627 rakwb eng de Somer, Filip verfasserin aut $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213 Mulholland, John W aut Bryan, Megan R aut Aloisio, Tommaso aut Van Nooten, Guido J aut Ranucci, Marco aut Enthalten in Critical care London : BioMed Central, 1997 15(2011), 4 vom: 10. Aug. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:15 year:2011 number:4 day:10 month:08 https://dx.doi.org/10.1186/cc10349 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2011 4 10 08
allfieldsSound	10.1186/cc10349 doi (DE-627)SPR02983077X (SPR)cc10349-e DE-627 ger DE-627 rakwb eng de Somer, Filip verfasserin aut $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? 2011 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213 Mulholland, John W aut Bryan, Megan R aut Aloisio, Tommaso aut Van Nooten, Guido J aut Ranucci, Marco aut Enthalten in Critical care London : BioMed Central, 1997 15(2011), 4 vom: 10. Aug. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:15 year:2011 number:4 day:10 month:08 https://dx.doi.org/10.1186/cc10349 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2011 4 10 08
language	English
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author	de Somer, Filip
spellingShingle	de Somer, Filip misc Acute Kidney Injury misc Pump Flow misc Acute Kidney Injury Stage misc Postoperative Renal Function misc Negative Predictive Power $ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
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topic_title	$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? Acute Kidney Injury (dpeaa)DE-He213 Pump Flow (dpeaa)DE-He213 Acute Kidney Injury Stage (dpeaa)DE-He213 Postoperative Renal Function (dpeaa)DE-He213 Negative Predictive Power (dpeaa)DE-He213
topic	misc Acute Kidney Injury misc Pump Flow misc Acute Kidney Injury Stage misc Postoperative Renal Function misc Negative Predictive Power
topic_unstemmed	misc Acute Kidney Injury misc Pump Flow misc Acute Kidney Injury Stage misc Postoperative Renal Function misc Negative Predictive Power
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title	$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
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title_full	$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
author_sort	de Somer, Filip
journal	Critical care
journalStr	Critical care
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author_browse	de Somer, Filip Mulholland, John W Bryan, Megan R Aloisio, Tommaso Van Nooten, Guido J Ranucci, Marco
container_volume	15
format_se	Elektronische Aufsätze
author-letter	de Somer, Filip
doi_str_mv	10.1186/cc10349
title_sort	$ o_{2} $ delivery and $ co_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
title_auth	$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
abstract	Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (
abstractGer	Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (
abstract_unstemmed	Introduction Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery ($ DO_{2} $) and carbon dioxide production ($ VCO_{2} $)) during CPB with postoperative AKI. Methods We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The $ DO_{2} $ and $ VCO_{2} $ levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir $ DO_{2} $ values and nadir $ DO_{2} $/$ VCO_{2} $ ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage. Results A nadir $ DO_{2} $ level < 262 mL/minute/$ m^{2} $ and a nadir $ DO_{2} $/$ VCO_{2} $ ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir $ DO_{2} $ levels and nadir $ DO_{2} $/$ VCO_{2} $ ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir $ DO_{2} $ level. Conclusions The nadir $ DO_{2} $ level during CPB is independently associated with postoperative AKI. The measurement of $ VCO_{2} $-related variables does not add accuracy to the AKI prediction. Since $ DO_{2} $ during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the $ DO_{2} $ level above the identified critical value might limit the incidence of postoperative AKI. © de Somer et al.; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (
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container_issue	4
title_short	$ O_{2} $ delivery and $ CO_{2} $ production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?
url	https://dx.doi.org/10.1186/cc10349
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author2	Mulholland, John W Bryan, Megan R Aloisio, Tommaso Van Nooten, Guido J Ranucci, Marco
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up_date	2024-07-04T02:26:14.586Z
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