A norepinephrine weaning strategy using dynamic arterial elastance is associated with reduction of acute kidney injury in patients with vasoplegia after cardiac surgery : A post-hoc analysis of the randomized SNEAD study
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: To evaluate the impact of a dynamic arterial elastance guided norepinephrine weaning strategy on the occurrence of acute kidney injury (AKI) in patients with vasoplegia after cardiac surgery.
DESIGN: A post-hoc analysis of a monocentric randomized controlled trial.
SETTING: A tertiary care hospital in France.
PARTICIPANTS: Vasoplegic cardiac surgical patients treated with norepinephrine.
INTERVENTION: Patients were randomized to an algorithm-based norepinephrine weaning intervention (dynamic arterial elastance) group or a control group.
MEASUREMENTS: The primary endpoint was the number of patients with AKI defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The secondary endpoint were major adverse cardiac post-operative events (new onset of atrial fibrillation or flutter, low cardiac output syndrome, and in-hospital death). End points were evaluated during the first seven post-operative days.
RESULTS: 118 patients were analyzed. In the overall study population, the mean age was 70 (62-76) years, 65% were male and the median EuroSCORE was 7 (5-10). Overall, 46 (39%) patients developed AKI (30 KDIGO 1, 8 KDIGO 2, 8 KDIGO 3), and 6 patients required renal replacement therapy. The incidence of AKI was significantly lower in the intervention group than in the control group (16 patients (27%) vs 30 patients (51%), p = 0.12). Higher dose and longer duration of norepinephrine were associated with AKI severity.
CONCLUSION: Decreasing norepinephrine exposure by using a dynamic arterial elastance guided norepinephrine weaning strategy was associated with a reduced incidence of acute kidney injury in patients with vasoplegia after cardiac surgery. Further prospective multicentric studies are needed to confirm these results.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:88 |
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| Enthalten in: |
Journal of clinical anesthesia - 88(2023) vom: 15. Sept., Seite 111124 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Guinot, Pierre-Grégoire [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 07.06.2023 Date Revised 07.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinane.2023.111124 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Guinot, Pierre-Grégoire |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A norepinephrine weaning strategy using dynamic arterial elastance is associated with reduction of acute kidney injury in patients with vasoplegia after cardiac surgery |b A post-hoc analysis of the randomized SNEAD study |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a STUDY OBJECTIVE: To evaluate the impact of a dynamic arterial elastance guided norepinephrine weaning strategy on the occurrence of acute kidney injury (AKI) in patients with vasoplegia after cardiac surgery | ||
| 520 | |a DESIGN: A post-hoc analysis of a monocentric randomized controlled trial | ||
| 520 | |a SETTING: A tertiary care hospital in France | ||
| 520 | |a PARTICIPANTS: Vasoplegic cardiac surgical patients treated with norepinephrine | ||
| 520 | |a INTERVENTION: Patients were randomized to an algorithm-based norepinephrine weaning intervention (dynamic arterial elastance) group or a control group | ||
| 520 | |a MEASUREMENTS: The primary endpoint was the number of patients with AKI defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The secondary endpoint were major adverse cardiac post-operative events (new onset of atrial fibrillation or flutter, low cardiac output syndrome, and in-hospital death). End points were evaluated during the first seven post-operative days | ||
| 520 | |a RESULTS: 118 patients were analyzed. In the overall study population, the mean age was 70 (62-76) years, 65% were male and the median EuroSCORE was 7 (5-10). Overall, 46 (39%) patients developed AKI (30 KDIGO 1, 8 KDIGO 2, 8 KDIGO 3), and 6 patients required renal replacement therapy. The incidence of AKI was significantly lower in the intervention group than in the control group (16 patients (27%) vs 30 patients (51%), p = 0.12). Higher dose and longer duration of norepinephrine were associated with AKI severity | ||
| 520 | |a CONCLUSION: Decreasing norepinephrine exposure by using a dynamic arterial elastance guided norepinephrine weaning strategy was associated with a reduced incidence of acute kidney injury in patients with vasoplegia after cardiac surgery. Further prospective multicentric studies are needed to confirm these results | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Cardiac | |
| 650 | 4 | |a Dynamic arterial elastance | |
| 650 | 4 | |a Norepinephrine | |
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| 650 | 4 | |a sepsis | |
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| 700 | 1 | |a Bouhemad, Belaid |e verfasserin |4 aut | |
| 700 | 1 | |a Abou-Arab, Osama |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Maxime |e verfasserin |4 aut | |
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