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Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass
Brian C Ayers1, Raimon Padrós-Valls2, Sarah Brownlee1
1Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Journal of Cardiothoracic and Vascular Anesthesia
|December 7, 2024
Summary
Higher critical closing pressure (Pcrit) before cardiopulmonary bypass (CPB) is linked to increased risk of acute kidney injury (AKI). This finding may help personalize blood pressure targets during cardiac surgery to prevent AKI.
Area of Science:
- Cardiovascular Physiology
- Nephrology
- Anesthesiology
Background:
- Optimal blood pressure management during cardiopulmonary bypass (CPB) is not well-defined.
- Newer metrics are needed to individualize perfusion targets in cardiac surgery.
- Critical closing pressure (Pcrit) reflects vascular tone and systemic circulation outflow pressure.
Purpose of the Study:
- To investigate Pcrit as a prognostic marker for acute kidney injury (AKI) in adult cardiac surgery patients.
- To determine the association between prebypass Pcrit and the incidence of postoperative AKI.
Main Methods:
- Retrospective cohort study of 1,038 adult patients undergoing cardiac surgery with CPB.
- Pcrit was calculated from arterial waveform data prior to CPB initiation.
- AKI was defined as stage 2 or higher using Kidney Disease Improving Global Outcomes criteria.
Main Results:
- 5% of patients developed AKI.
- Patients with AKI had higher preoperative risk factors and longer operative times.
- A higher prebypass Pcrit was significantly associated with increased AKI incidence (p=0.018).
- Each 5 mmHg increase in prebypass Pcrit correlated with a 16% higher risk of AKI (p=0.011).
Conclusions:
- Elevated prebypass Pcrit is a significant predictor of postoperative AKI.
- Further research is needed to explore intraoperative Pcrit for personalized blood pressure goals during CPB.
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