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. - 03/06/23
, Pierre Huette c, Belaid Bouhemad a, b, Osama Abou-Arab c, Maxime Nguyen a, bAbstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Norepinephrine dose is associated with acute kidney injury (AKI) after cardiac surgery. |
• | A dynamic elastance based norepinephrine weaning strategy decreased the incidence of acute kidney injury. |
• | Higher dose and longer duration of norepinephrine were associated with AKI severity. |
Keywords : Norepinephrine, Vasopressor, Acute kidney injury, Dynamic arterial elastance, Cardiac, sepsis
Abbreviations : AKI, CI, MAP, KDIGO, ScVO2, SOFA
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Vol 88
Article 111124- septembre 2023 Retour au numéro
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