Timing matters: the delicate balance in amino acids infusion duration in cardiac surgery

A secondary analysis of the PROTECTION trial found that intravenous infusion of amino acids perioperatively reduced acute kidney injury in patients undergoing cardiac surgery. A new report of a post hoc analysis of that trial suggests that although the renal protective effects of amino acid infusion were consistent, a shorter duration of infusion (≤48 h) might be associated with lower ICU mortality compared with a prolonged infusion (up to 72 h), possibly because of reduced nitrogen waste accumulation. Although observational, these findings caution against unnecessarily extending an amino acid infusion beyond the immediate perioperative period. Pending definitive evidence, this analysis suggests the optimal balance can be achieved by restricting infusion to a 48-h window.