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2014 ; 2014
(ä): 917985
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May Renal Resistive Index be an early predictive tool of postoperative
complications in major surgery? Preliminary results
#MMPMID24967414
Giustiniano E
; Meco M
; Morenghi E
; Ruggieri N
; Cosseta D
; Cirri S
; Difrancesco O
; Zito PC
; Gollo Y
; Raimondi F
Biomed Res Int
2014[]; 2014
(ä): 917985
PMID24967414
show ga
BACKGROUND: Patients who undergo high-risk surgery represent a large amount of
post-operative ICU-admissions. These patients are at high risk of experiencing
postoperative complications. Renal Resistive Index was found to be related with
renal dysfunction, hypertension, and posttraumatic hemorrhagic shock, probably
due to vasoconstriction. We explored whether Renal Resistive Index (RRI),
measured after awakening from general anesthesia, could have any relationship
with postoperative complications. METHODS: In our observational, stratified
dual-center trial, we enrolled patients who underwent general anesthesia for
high-risk major surgery. After awakening in recovery room (or during awakening
period in subjects submitted to cardiac surgery) we measured RRI by
echo-color-Doppler method. Primary endpoint was the association of altered RRI
(>0.70) and outcome during the first postoperative week. RESULTS: 205 patients
were enrolled: 60 (29.3%) showed RRI > 0.70. The total rate of adverse event was
27 (18.6%) in RRI ? 0.7 group and 19 (31.7%) in RRI > 0.7 group (P = 0.042).
Significant correlation between RRI > 0.70 and complications resulted in
pneumonia (P = 0.016), septic shock (P = 0.003), and acute renal failure (P =
0.001) subgroups. Patients with RRI > 0.7 showed longer ICU stay (P = 0.001) and
lasting of mechanical ventilation (P = 0.004). These results were confirmed in
cardiothoracic surgery subgroup. RRI > 0.7 duplicates triplicates the risk of
complications, both in general (OR 2.03 93 95% CI 1.02-4.02, P = 0.044) and in
cardiothoracic (OR 2.62 95% CI 1.11-6.16, P = 0.027) population. Furthermore, we
found RRI > 0.70 was associated with a triplicate risk of postoperative septic
shock (OR 3.04, CI 95% 1.5-7.01; P = 0.002).