Department of Anesthesiology and Perioperative Medicine, the University of Texas, MD Anderson Cancer Center, Houston, TX.
Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio.
J Cardiothorac Vasc Anesth. 2023 Sep;37(9):1579-1590. doi: 10.1053/j.jvca.2023.05.032. Epub 2023 May 23.
Acute kidney injury (AKI) is increasingly recognized as a source of poor patient outcomes after cardiac surgery. The purpose of the present report is to provide perioperative teams with expert recommendations specific to cardiac surgery-associated AKI (CSA-AKI).
This report and consensus recommendations were developed during a joint, in-person, multidisciplinary conference with the Perioperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. Multinational practitioners with diverse expertise in all aspects of cardiac surgical perioperative care, including clinical backgrounds in anesthesiology, surgery and nursing, met from October 20 to 22, 2021, in Sacramento, California, and used a modified Delphi process and a comprehensive review of evidence to formulate recommendations. The quality of evidence and strength of each recommendation were established using the Grading of Recommendations Assessment, Development, and Evaluation methodology. A majority vote endorsed recommendations.
Based on available evidence and group consensus, a total of 13 recommendations were formulated (4 for the preoperative phase, 4 for the intraoperative phase, and 5 for the postoperative phase), and are reported here.
Because there are no reliable or effective treatment options for CSA-AKI, evidence-based practices that highlight prevention and early detection are paramount. Cardiac surgery-associated AKI incidence may be mitigated and postsurgical outcomes improved by focusing additional attention on presurgical kidney health status; implementing a specific cardiopulmonary bypass bundle; using strategies to maintain intravascular euvolemia; leveraging advanced tools such as the electronic medical record, point-of-care ultrasound, and biomarker testing; and using patient-specific, goal-directed therapy to prioritize oxygen delivery and end-organ perfusion over static physiologic metrics.
急性肾损伤（AKI）越来越被认为是心脏手术后患者预后不良的一个原因。本报告的目的是为围手术期团队提供与心脏手术相关的 AKI（CSA-AKI）相关的专家建议。
本报告和共识建议是在 2021 年 10 月 20 日至 22 日于加利福尼亚州萨克拉门托举行的围手术期质量倡议和术后恢复加速心脏协会联合现场多学科会议上制定的。具有心脏手术围手术期护理各个方面专业知识的多国从业者，包括麻醉、手术和护理方面的临床背景，从 2021 年 10 月 20 日至 22 日在加利福尼亚州萨克拉门托举行了会议，并使用改良 Delphi 流程和对证据的全面审查制定了建议。使用推荐评估、制定和评估方法学来确定证据质量和每项建议的强度。多数票支持建议。
根据现有证据和小组共识，共制定了 13 项建议（术前阶段 4 项，术中阶段 4 项，术后阶段 5 项），现报告如下。
由于 CSA-AKI 没有可靠或有效的治疗选择，因此强调预防和早期发现的循证实践至关重要。通过更多地关注术前肾脏健康状况；实施特定的体外循环捆绑包；使用维持血管内血容量正常的策略；利用电子病历、即时超声和生物标志物检测等先进工具；以及使用基于患者的、目标导向的治疗来优先考虑氧输送和终末器官灌注而不是静态生理指标，可能会减轻 CSA-AKI 的发生率并改善术后结果。
