Goal-directed perfusion to reduce acute kidney injury: A randomized trial
Goal-directed perfusion to reduce acute kidney injury: A randomized trial
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DOI：
10.1016/j.jtcvs.2018.04.045
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发表时间：
2018-11-01
影响因子：
6
通讯作者：
Pistuddi, Valeria
中科院分区：
文献类型：
--
作者：
Ranucci, Marco;Johnson, Ian;Pistuddi, Valeria
目的：确定目标导向灌注（GDP）策略是否旨在维持氧输送（DO2）≥ 280 mL. min（-1）. m（-2）降低急性肾损伤（AKI）的发生率。方法：这项多中心随机试验共纳入了9家机构的350例心脏手术患者。患者随机接受GDP或常规灌注。共有326名患者完成了研究并进行了分析。治疗组患者在体外循环（CPB）期间采用GDP策略治疗，旨在维持DO2>= 280 mL. min（-1）. m（-2）。对照组患者的灌注策略是基于体表面积和体温。主要终点为AKI发生率。次要终点是重症监护病房的住院时间，主要发病率，红细胞输注，和手术mortals.Results：急性肾损伤网络（AKIN）阶段1与GDP治疗的患者减少（相对风险[RR]，0.45; 95%置信区间[CI]，0.25 - 0.83; P = 0.01）。AKIN 2 - 3期在两个研究组之间没有差异（RR，1.66; 95% CI，0.46 - 6.0; P = 0.528）。次要结局无显著差异。在CPB时间在1至3小时之间的患者的预先规定的分析中，有利于治疗组的差异更明显，AKI的RR为0.49（95%CI，0.27 - 0.89; P = 0.017）。需要进一步的研究来确定灌注干预，可能会降低更严重的肾损伤水平（AKIN 2或3期）。
Objective: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2) at >= 280 mL.min(-1).m(-2) reduces the incidence of acute kidney injury (AKI).Methods: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at >= 280 mL.min(-1).m(-2). The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality.Results: Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with an RR for AKI of 0.49 (95% CI, 0.27-0.89; P = .017).Conclusions: A GDP strategy is effective in reducing AKIN stage 1 AKI. Further studies are needed to define perfusion interventions that may reduce more severe levels of renal injury (AKIN stage 2 or 3).