O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury time for a goal-directed perfusion management 英文参考文献.docVIP

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O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury time for a goal-directed perfusion management 英文参考文献.doc

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O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury time for a goal-directed perfusion management 英文参考文献

O2deliveryandCO2productionduring cardiopulmonarybypassasdeterminantsofacute kidneyinjury:timeforagoal-directedperfusion management? deSomeretal. deSomeretal.CriticalCare2011,15:R192 /content/15/4/R192(10August2011) deSomeretal.CriticalCare2011,15:R192 /content/15/4/R192 RESEARCH OpenAccess O2deliveryandCO2productionduring cardiopulmonarybypassasdeterminantsofacute kidneyinjury:timeforagoal-directedperfusion management? FilipdeSomer1,JohnWMulholland2,MeganRBryan2,TommasoAloisio3,GuidoJVanNooten1and MarcoRanucci3* Abstract Introduction:Acutekidneyinjury(AKI)iscommonaftercardiacoperations.Therearedifferentriskfactorsor determinantsofAKI,andsomearerelatedtocardiopulmonarybypass(CPB).Inthisstudy,weexploredthe associationbetweenmetabolicparameters(oxygendelivery(DO2)andcarbondioxideproduction(VCO2 ))during CPBwithpostoperativeAKI. Methods:Weconductedaretrospectiveanalysisofprospectivelycollecteddataattwodifferentinstitutions.The studypopulationincluded359adultpatients.TheDO2andVCO2levelsofeachpatientweremonitoredduring CPB.Outcomevariableswererelatedtokidneyfunction(peakpostoperativeserumcreatinineincreaseandAKI stage1or2).TheexperimentalhypothesiswasthatnadirDO2valuesandnadirDO2/VCO2ratiosduringCPBwould beindependentpredictorsofAKI.Multivariablelogisticregressionmodelswerebuilttodetecttheindependent predictorsofAKIandanykindofkidneyfunctiondamage. Results:AnadirDO2level262mL/minute/m2andanadirDO2/VCO2ratio5.3wereindependentlyassociated withAKIwithinamodelincludingEuroSCOREandCPBduration.PatientswithnadirDO2levelsandnadirDO2/VCO2 ratiosbelowtheidentifiedcutoffvaluesduringCPBhadasignificantlyhigherrateofAKIstage2(oddsratios3.1and 2.9,respectively).Thenegativepredictivepowerofbothvariablesexceeded90%.ThemostaccuratepredictorofAKI stage2postoperativestatuswasthenadirDO2level. Conclusions:ThenadirDO2levelduringCPBisindependentlyassociatedwithpostoperativeAKI.The measurementofVCO2-relatedvariablesdoesnotaddaccuracytotheAKIprediction.SinceDO2duringCPBisa modifiablefactor(t