Luckraz Heyman, Giri Ramesh, Wrigley Benmjamin, Hennessy Anne-Marie, Nicholas Johann, Nevill Alan
Department of Cardiothoracic Surgery, Heart & Lung Centre, Wolverhampton, UK.
Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre, Wolverhampton, UK.
Open Heart. 2017 Oct 10;4(2):e000669. doi: 10.1136/openhrt-2017-000669. eCollection 2017.
As proof of concept, this prospective, observational study assessed the feasibility and early clinical outcomes of performing on-pump cardiac surgery with the RenalGuard system.
Acute kidney injury (AKI) is reported in up to 30% of patients undergoing cardiac surgery and is a recognised independent predictor of both morbidity and mortality. Forced diuresis with the RenalGuard system reduces the incidence of AKI during percutaneous coronary intervention procedures but its use in cardiac surgery has not been explored.
Ten consecutive patients who were at risk of developing AKI during cardiac surgery were selected. The RenalGuard system was used to facilitate forced diuresis using weight-adjusted intravenous furosemide while maintaining neutral fluid balance by matched intravenous fluid replacement. This regimen was initiated preoperatively in all patients and continued for 6-12 hours postoperatively. Serum creatinine, electrolytes and need for renal replacement were documented in all patients.
The RenalGuard system functioned successfully in all patients and facilitated high perioperative urine outputs, even when patients were placed on cardiopulmonary bypass (CPB). There were no incidences of significant (A) electrolyte imbalance, (B) changes in haemoglobin levels or (C) pulmonary oedema. No patients developed AKI within 36 hours of surgery despite one patient developing cardiac tamponade 8 hours postoperatively and one patient developing paralytic ileus. One patient, however, was 'electively' haemofiltered on day 2 after developing acute right ventricular failure. The median intensive care stay was 1.5 (1, 5) days.
The RenalGuard system can be used successfully in patients undergoing cardiac surgery with CPB and may reduce the incidence of AKI in at-risk patients.
NCT02974946; Pre-results.
作为概念验证，这项前瞻性观察性研究评估了使用RenalGuard系统进行体外循环心脏手术的可行性和早期临床结果。
据报道，高达30%的心脏手术患者会发生急性肾损伤（AKI），并且它是发病率和死亡率公认的独立预测因素。RenalGuard系统进行的强制利尿可降低经皮冠状动脉介入手术期间AKI的发生率，但尚未探索其在心脏手术中的应用。
选择了10例在心脏手术期间有发生AKI风险的连续患者。使用RenalGuard系统，通过体重调整静脉注射速尿促进强制利尿，同时通过匹配静脉补液维持中性液体平衡。该方案在所有患者术前开始，并在术后持续6至12小时。记录所有患者的血清肌酐、电解质以及肾脏替代治疗的需求。
RenalGuard系统在所有患者中均成功运行，并促进了围手术期的高尿量输出，即使患者进行体外循环（CPB）时也是如此。没有发生（A）明显的电解质失衡、（B）血红蛋白水平变化或（C）肺水肿。尽管有1例患者术后8小时发生心脏压塞，1例患者发生麻痹性肠梗阻，但没有患者在手术后36小时内发生AKI。然而，有1例患者在发生急性右心室衰竭后第2天“选择性”进行了血液滤过。重症监护病房的中位住院时间为1.5（1，5）天。
RenalGuard系统可成功用于接受CPB心脏手术的患者，并可能降低高危患者AKI的发生率。
NCT02974946；预结果。
