Acute and Critical Care

Original Article

Thoracic Surgery
Perfusion parameters during cardiopulmonary bypass as a predictor of acute kidney injury after aortic valve replacement: Yeiwon Lee, Sue Hyun Kim, Ho Young Hwang, Suk Ho Sohn, Jae Woong Choi, Kyung Hwan Kim; Acute Crit Care. 2021;36(3):242-248. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00094

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Background
Acute kidney injury (AKI) is a major complication after cardiac surgery and significantly affects postoperative mortality and morbidity. This study was conducted to evaluate the association between target pump flow to achieve adequate oxygen delivery (DO₂) and postoperative renal function after aortic valve replacement.
Methods
From January 2017 to May 2020, 281 patients (male:female, 160:121; mean age, 68±11 years) who underwent aortic valve replacement were retrospectively reviewed. Target pump flow was calculated based on DO₂ level of 280 mL/min/m². The primary endpoint was postoperative renal dysfunction, defined as the ratio of postoperative peak creatinine level to preoperative value. The ratio of the lowest actual pump flow to the ideal target pump flow, other hemodynamic variables related with cardiopulmonary bypass, intraoperative transfusion, and preoperative characteristics were analyzed to identify factors associated with the primary endpoint using a multivariable linear regression model.
Results
Preoperative and peak postoperative creatinine levels were 0.94±0.33 mg/dl and 1.15±0.56 mg/dl, respectively (ratio, 1.22±0.33). The ideal target pump flow was 4.70±0.59 L/min, whereas the lowest actual pump flow was 3.77±0.47 L/min (ratio, 0.81±0.13). The multivariable model showed that the ratio of the lowest pump flow to target pump flow (β±standard error, –0.405±0.162, P=0.013), as well as sex, stroke history, emergency operation, and transfusion of red blood cells were associated with the primary endpoint.
Conclusions
Low actual nadir pump flow compared to the ideal target pump flow based on DO₂ is associated with the risk of AKI after aortic valve replacement.

Citations

Citations to this article as recorded by

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks
Jakub Udzik, Jerzy Pacholewicz, Andrzej Biskupski, Paweł Walerowicz, Kornelia Januszkiewicz, Ewa Kwiatkowska
Journal of Clinical Medicine.2023; 12(21): 6894. CrossRef

Case Report

Thoracic Surgery
Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery: Sue Hyun Kim, Ho Young Hwang, Min Jung Kim, Kyu Joo Park, Ki-Bong Kim; Acute Crit Care. 2020;35(3):213-217. Published online April 19, 2019; DOI: https://doi.org/10.4266/acc.2018.00423

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Abstract PDF

Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but fatal complication. Early diagnosis and intervention can be lifesaving. We report two cases of patients who underwent early diagnostic laparoscopy for suspicious AMI after cardiac surgery and demonstrated favorable outcomes. An 83-year-old male with severe left ventricular dysfunction underwent off-pump coronary artery bypass grafting. Severe ileus with gaseous distension of the small bowel was developed on the 3rd postoperative day and computed tomographic angiography (CTA) showed pneumatosis intestinalis of small bowel suggestive of AMI. An immediate bedside laparoscopy was performed and it showed preserved perfusion of small bowel. He recovered without complication under supportive medical management. Another 69-year-old male who underwent aortic valve replacement complained of whole abdominal tenderness with severe distension on the 3rd postoperative day. The CTA found segmental non-enhancing bowel wall with air bubbles suggestive of AMI with possible microperforation. A diagnostic laparoscopy demonstrated small-bowel infarction with pus-like fluid collection in the peritoneal cavity. The operation was converted to laparotomy and complete resection of ischemic segments of small bowel was done. He recovered well without any other complications and discharged home on the 35th postoperative day.

Citations

Citations to this article as recorded by

The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review
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Journal of Personalized Medicine.2024; 14(2): 167. CrossRef
Gastrointestinal complications after cardiac surgery
Klara Schwarzova, Sameer Damle, Frank William Sellke, Michael Phillip Robich
Trauma Surgery & Acute Care Open.2024; 9(1): e001324. CrossRef
The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU
Carlo Bergamini, Giovanni Alemanno, Alessio Giordano, Desiré Pantalone, Giovanni Fontani, Anna Maria Di Bella, Veronica Iacopini, Paolo Prosperi, Jacopo Martellucci
European Journal of Trauma and Emergency Surgery.2022; 48(1): 87. CrossRef
Minimally invasive acute care surgery
Caroline E. Reinke, Robert B. Lim
Current Problems in Surgery.2022; 59(2): 101031. CrossRef
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Journal of Cardiac Surgery.2022; 37(7): 2040. CrossRef

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