The following is a summary of the “Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Mukaida et al.
The oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management vs. fixed flow perfusion (conventional strategy) for reducing postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery is still debatable. This research aimed to see if patients undergoing cardiopulmonary bypass surgery could experience less postoperative acute kidney injury if they were given oxygen as part of the procedure.
The 300 patients undergoing cardiopulmonary bypass surgery were all enrolled at random. Cardiopulmonary bypass patients were randomly assigned to either an oxygen delivery strategy (where the oxygen delivery index value is kept above 300 mL/min/m) or a standard strategy (a target pump flow was determined based on the body surface area). This study’s primary outcome measure was the occurrence of acute kidney injury. Red blood cell transfusion rate, the number of red blood cell units, intubation duration, postoperative ICU and hospital length of stay, predischarge estimated glomerular filtration rate, and hospital mortality were secondary endpoints.
Around 20 patients (14.6%) receiving the oxygen delivery strategy and 42 patients (30.4%) receiving the conventional strategy developed acute kidney injury (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P =.002). There was no significant difference in secondary outcomes between approaches. The oxygen delivery strategy appeared to be superior to the conventional strategy, and the existence of quantitative interactions was suggested in a prespecified subgroup analysis of patients with nadir hematocrit less than 23% or body surface area less than 1.40 m. When it came to avoiding kidney damage during cardiopulmonary bypass, an oxygen delivery strategy fared better than the status quo.