Acute and Critical Care

Original Articles

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

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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

Procalcitonin as a Prognosis Marker for the Severe Sepsis and Septic Shock Patients in Emergency Department: Seung Woon Choi, Hoon Kim, Kyung Hwan Kim, Dong Wun Shin, Jun Seok Park, Jun Young Roh, Jun Min Park; Korean J Crit Care Med. 2011;26(4):250-255.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.250

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Abstract PDF

BACKGROUND
Advance in sepsis management has increased the survival of patients with sepsis. However, severe sepsis and septic shock patients still have high mortality. We intend to verify the use of the procalcitonin (PCT) level as a prognosis marker in patients with severe sepsis or septic shock in the emergency department (ED).
METHODS
ED Patients with severe sepsis or septic shock were enrolled in our study. We used mortality and Intensive Care Unit (ICU) days as a prognosis index, and compared the PCT level in survivors and non-survivors. We introduced the simplified acute physiology score 3(SAPS3) to assess the severity of the patients and analyzed whether or not the PCT level correlated with the severity index.
RESULTS
The PCT level in septic shock patients [7.36 (0.92-33.69, IQR)] was higher than that in severe sepsis patients [3.24 (0.36-10.53, IQR)] (p = 0.04). However, there was no significant PCT level difference between survivors [median (IQR), 6.59 (0.60-29.25)] and non-survivors [median (IQR), 3.49 (0.40-20.41)] (p = 0.293). The SAPS3 score was higher in the non-survivor group [median (IQR), 64 (59.0-71.5)] than in the survivor group [median (IQR), 77 (68.5-82.0)] (p = 0.001). The PCT level did not correlate with either ICU days or hospital days.
CONCLUSIONS
Using the PCT level as a prognosis factor in severe sepsis and septic shock patients in ED has little value.

Citations

Citations to this article as recorded by

Procalcitonin as a prognostic marker for sepsis: a prospective observational study
Saransh Jain, Sanjeev Sinha, Surendra K Sharma, J C Samantaray, Praveen Aggrawal, Naval Kishore Vikram, Ashutosh Biswas, Seema Sood, Manish Goel, Madhuchhanda Das, Sreenivas Vishnubhatla, Nawaid Khan
BMC Research Notes.2014;[Epub] CrossRef

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