TY - JOUR
T1 - Potential Renoprotective Strategies in Adult Cardiac Surgery
T2 - A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making
AU - McIlroy, David R.
AU - Roman, Bennett
AU - Billings, Frederic T.
AU - Bollen, Bruce A.
AU - Fox, Amanda
AU - Geube, Mariya
AU - Liu, Hong
AU - Shore-Lesserson, Linda
AU - Zarbock, Alexander
AU - Shaw, Andrew D.
N1 - Funding Information:
Drs. McIlroy and Shore-Lesserson are members of the editorial board of the Journal of Cardiothoracic and Vascular Anesthesia. One of the authors (Dr A. Fox) is supported by an NIH grant that needs to be acknowledged/declared in association with the manuscript. The details of the grant funding are as follows: NIH NHLBI 1-R01HL148448 (AF PI)
Funding Information:
Drs. McIlroy and Shore-Lesserson are members of the editorial board of the Journal of Cardiothoracic and Vascular Anesthesia. One of the authors (Dr A. Fox) is supported by an NIH grant that needs to be acknowledged/declared in association with the manuscript. The details of the grant funding are as follows: NIH NHLBI 1-R01HL148448 (AF PI)
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/7
Y1 - 2021/7
N2 - Objectives: The authors sought to (1) characterize the rationale underpinning anesthesiologists’ use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which anesthesiologists would most value a detailed, evidence-based review. Design: Survey of perioperative practice in adult patients undergoing cardiac surgery. Setting: Online survey. Participants: Members of the Society of Cardiovascular Anesthesiologists (SCA). Interventions: None. Measurements & Main Results: The survey was distributed to more than 2,000 SCA members and completed in whole or in part by 202 respondents. Selection of target intraoperative blood pressure (and relative hypotension avoidance) was the strategy most frequently reported to reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most respondents believed the evidence supporting an effect on renal injury of intraoperative target blood pressure during cardiac surgery was of high or moderate quality. Other factors, including a specific nonrenal rationale, surgeon preference, department- or institution-level decisions, tradition, or habit, also frequently were reported to affect decision making across queried strategies. Potential renoprotective strategies most frequently requested for inclusion in a subsequent detailed, evidence-based review were intraoperative target blood pressure and choice of vasopressor agent to achieve target pressure. Conclusions: A large number of perioperative strategies are believed to variably affect renal injury in adult patients undergoing cardiac surgery, with wide variation in perceived quality of evidence for a renal effect of these strategies.
AB - Objectives: The authors sought to (1) characterize the rationale underpinning anesthesiologists’ use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which anesthesiologists would most value a detailed, evidence-based review. Design: Survey of perioperative practice in adult patients undergoing cardiac surgery. Setting: Online survey. Participants: Members of the Society of Cardiovascular Anesthesiologists (SCA). Interventions: None. Measurements & Main Results: The survey was distributed to more than 2,000 SCA members and completed in whole or in part by 202 respondents. Selection of target intraoperative blood pressure (and relative hypotension avoidance) was the strategy most frequently reported to reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most respondents believed the evidence supporting an effect on renal injury of intraoperative target blood pressure during cardiac surgery was of high or moderate quality. Other factors, including a specific nonrenal rationale, surgeon preference, department- or institution-level decisions, tradition, or habit, also frequently were reported to affect decision making across queried strategies. Potential renoprotective strategies most frequently requested for inclusion in a subsequent detailed, evidence-based review were intraoperative target blood pressure and choice of vasopressor agent to achieve target pressure. Conclusions: A large number of perioperative strategies are believed to variably affect renal injury in adult patients undergoing cardiac surgery, with wide variation in perceived quality of evidence for a renal effect of these strategies.
KW - acute kidney injury
KW - perioperative
KW - thoracic surgery
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U2 - 10.1053/j.jvca.2021.02.004
DO - 10.1053/j.jvca.2021.02.004
M3 - Article
C2 - 33674203
AN - SCOPUS:85101869155
SN - 1053-0770
VL - 35
SP - 2043
EP - 2051
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 7
ER -