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10.1016/j.jtcvs.2016.09.016 http://scihub22266oqcxt.onion/10.1016/j.jtcvs.2016.09.016 C5517016!5517016 !27832832     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27832832 &cmd=llinks): Failed to open stream: HTTP request failed! 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A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery |pdf=|usr=}}{{27832832 }} gab.com Text A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery JO: J Thorac Cardiovasc Surg http://www.kidney.de/pget.php?&tw=1&pmid=27832832 #FOAvip BACKGROUND: We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. METHODS: On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m(2) and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. RESULTS: We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m(2), P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). CONCLUSIONS: The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study. Twit Text FOAVip A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery ????J Thorac Cardiovasc Surg http://www.kidney.de/pget.php?&tw=1&pmid=27832832 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27832832 #FOAvip English Wikipedia <ref>{{Cite pmid|27832832 }}</ref> A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery #MMPMID27832832 Magruder JT ; Crawford TC ; Harness HL ; Grimm JC ; Suarez-Pierre A ; Wierschke C ; Biewer J ; Hogue C ; Whitman GR ; Shah AS ; Barodka V J Thorac Cardiovasc Surg 2017[Jan]; 153 (1 ): 118-125.e1 PMID27832832 show ga BACKGROUND: We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. METHODS: On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m(2) and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. RESULTS: We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m(2), P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). CONCLUSIONS: The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study. |*Cardiac Surgical Procedures/adverse effects [MESH] |*Cardiopulmonary Bypass/adverse effects [MESH] |Acute Kidney Injury/diagnosis/epidemiology/*prevention & control [MESH] |Aged [MESH] |Aged, 80 and over [MESH] |Baltimore/epidemiology [MESH] |Female [MESH] |Humans [MESH] |Incidence [MESH] |Male [MESH] |Middle Aged [MESH] |Patient Care Bundles [MESH] |Perfusion/adverse effects/*methods [MESH] |Pilot Projects [MESH] |Protective Factors [MESH] |Retrospective Studies [MESH] |Risk Factors [MESH] |Time Factors [MESH]A pilot goal-directed perfusion initiative is associated with less acu(epmc).pdf DeepDyve Pubget Overpricing