Abstract: FR-PO107
Assessment of Individualized Mean Perfusion Pressure Target for Cardiac Surgery-Associated AKI: PrevHemAKI Trial
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Andújar, Alicia Molina, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Rios, Jose, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Piñeiro, Gastón Julio, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Poch, Esteban, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
Background
Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of post-operative acute kidney injury. The aim of our study was to apply an algorithm based on MPP = mean arterial pressure (MAP)-central venous pressure (CVP) in the postoperative period of cardiac surgery patients to determine whether management with an individualized target compared to standard treatment reduces the incidence of acute kidney injury (CC-AKI).
Methods
Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation between October 2019 and September 2022. Inclusion criteria were: adults with valve replacement and/or bypass surgery intervention with Leicester score >30. Patients were randomized to follow target of MPP >75% baseline vs standard follow-up during the first 24h.
Results
98 patients were recruited, 82.7% male with mean age 72.96 +- 7.25 years and eGFR of 55.3 +/-16.6 ml/min. 49 were randomized to the intervention arm and 49 to the standard treatment arm. Mean MAP during the intervention was higher in the intervention group (73.6/75.9 p=0.008), with no differences in mean MAP and MPP of the first 24h (75.5 vs 76.7, p=0.32 and 66.5 vs 67.5, p= 0.375 respectively) although a higher use of noradrenaline was found in the intervention arm (38.78 vs 63.27, p= 0.026). The percentage of time with MPP<75% baseline was similar in both groups (21.5/21.4%, p=0.811). Mean 24h fluid balance was similar (331 [-384-1206] vs 26 [-984-999], p=0.154). The incidence of CC-AKI was 36.7% (72.2% of them stage 1), with no differences between both groups but with a tendency to a higher incidence of AKI in the presence of PPM deficit of >20% (p=0.064).
Conclusion
There was a tendency to a higher incidence of AKI if MPP deficit >20% but individualized hemodynamic management based on MPP compared to standard treatment did not reduce the incidence of AKI associated to cardiac surgery in our study. Larger cohorts are needed in order to confirm these findings.
Funding
- Private Foundation Support