Article ; Online: 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.
Journal of clinical anesthesia
2023 Volume 88, Page(s) 111124
Abstract: 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 ... ...
| Abstract | 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. |
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| MeSH term(s) | Humans ; Male ; Aged ; Female ; Vasoplegia/drug therapy ; Vasoplegia/epidemiology ; Vasoplegia/etiology ; Norepinephrine/therapeutic use ; Hospital Mortality ; Weaning ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/methods ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Acute Kidney Injury/prevention & control |
| Chemical Substances | Norepinephrine (X4W3ENH1CV) |
| Language | English |
| Publishing date | 2023-04-24 |
| Publishing country | United States |
| Document type | Randomized Controlled Trial ; Journal Article |
| ZDB-ID | 1011618-7 |
| ISSN | 1873-4529 ; 0952-8180 |
| ISSN (online) | 1873-4529 |
| ISSN | 0952-8180 |
| DOI | 10.1016/j.jclinane.2023.111124 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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