Document Detail

Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury.
MedLine Citation:
PMID:  23263580     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine whether mean arterial blood pressure excursions below the lower limit of cerebral blood flow autoregulation during cardiopulmonary bypass are associated with acute kidney injury after surgery.
SETTING: Tertiary care medical center.
PATIENTS: Four hundred ten patients undergoing cardiac surgery with cardiopulmonary bypass.
DESIGN: Prospective observational study.
MEASUREMENTS AND MAIN RESULTS: Autoregulation was monitored during cardiopulmonary bypass by calculating a continuous, moving Pearson's correlation coefficient between mean arterial blood pressure and processed near-infrared spectroscopy signals to generate the variable cerebral oximetry index. When mean arterial blood pressure is below the lower limit of autoregulation, cerebral oximetry index approaches 1, because cerebral blood flow is pressure passive. An identifiable lower limit of autoregulation was ascertained in 348 patients. Based on the RIFLE criteria (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease), acute kidney injury developed within 7 days of surgery in 121 (34.8%) of these patients. Although the average mean arterial blood pressure during cardiopulmonary bypass did not differ, the mean arterial blood pressure at the limit of autoregulation and the duration and degree to which mean arterial blood pressure was below the autoregulation threshold (mm Hg × min/hr of cardiopulmonary bypass) were both higher in patients with acute kidney injury than in those without acute kidney injury. Excursions of mean arterial blood pressure below the lower limit of autoregulation (relative risk 1.02; 95% confidence interval 1.01 to 1.03; p < 0.0001) and diabetes (relative risk 1.78; 95% confidence interval 1.27 to 2.50; p = 0.001) were independently associated with for acute kidney injury.
CONCLUSIONS: Excursions of mean arterial blood pressure below the limit of autoregulation and not absolute mean arterial blood pressure are independently associated with for acute kidney injury. Monitoring cerebral oximetry index may provide a novel method for precisely guiding mean arterial blood pressure targets during cardiopulmonary bypass.
Masahiro Ono; George J Arnaoutakis; Derek M Fine; Kenneth Brady; R Blaine Easley; Yueying Zheng; Charles Brown; Nevin M Katz; Morgan E Grams; Charles W Hogue
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-08     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-71     Citation Subset:  AIM; IM    
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MeSH Terms
Acute Kidney Injury / physiopathology*
Blood Pressure / physiology*
Brain / blood supply*
Cardiopulmonary Bypass*
Diabetes Mellitus / physiopathology
Homeostasis / physiology*
Middle Aged
Monitoring, Intraoperative*
Prospective Studies
ROC Curve
Spectroscopy, Near-Infrared
Grant Support
Comment In:
Crit Care Med. 2013 Feb;41(2):671-2   [PMID:  23353951 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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