Acute Kidney Injury Subsequent to Cardiac Surgery
#MMPMID26390675
Kramer RS
; Herron CR
; Groom RC
; Brown JR
J Extra Corpor Technol
2015[Mar]; 47
(1
): 16-28
PMID26390675
show ga
Acute kidney injury (AKI) after cardiac surgery is a common and underappreciated
syndrome that is associated with poor shortand long-term outcomes. AKI after
cardiac surgery may be epiphenomenon, a signal for adverse outcomes by virtue of
other affected organ systems, and a consequence of multiple factors. Subtle
increases in serum creatinine (SCr) postoperatively, once considered
inconsequential, have been shown to reflect a kidney injury that likely occurred
in the operating room during cardiopulmonary bypass (CPB) and more often in
susceptible individuals. The postoperative elevation in SCr is a delayed signal
reflecting the intraoperative injury. Preoperative checklists and the conduct of
CPB represent opportunities for prevention of AKI. Newer definitions of AKI
provide us with an opportunity to scrutinize perioperative processes of care and
determine strategies to decrease the incidence of AKI subsequent to cardiac
surgery. Recognizing and mitigating risk factors preoperatively and optimizing
intraoperative practices may, in the aggregate, decrease the incidence of AKI.
This review explores the pathophysiology of AKI and addresses the features of
patients who are the most vulnerable to AKI. Preoperative strategies are
discussed with particular attention to a readiness for surgery checklist.
Intraoperative strategies include minimizing hemodilution and maximizing oxygen
delivery with specific suggestions regarding fluid management and plasma
preservation.
|Acute Kidney Injury/etiology/*mortality/*prevention & control
[MESH]
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