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Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury.
J Crit Care. 2014 Dec; 29(6):997-1000.JC

Abstract

OBJECTIVE

The purpose of this study was to assess the effect of goal-directed therapy (GDT), after cardiac surgery, on the incidence of acute kidney injury (AKI).

DESIGN

This is a prospective observational study designed to achieve and maintain maximum stroke volume for 8 hours, in patients after cardiac surgery.

SETTING

This is a single-center study in a 15-bedded cardiothoracic intensive care unit (ICU).

PARTICIPANTS

Participants are patients after coronary artery bypass grafting and/or aortic valve surgery.

INTERVENTIONS

Patients in the GDT group received cardiac output monitoring and fluid challenges targeting an increase in stroke volume by at least 10%. Stroke volume maximization was maintained for a period of 8 hours from admission to the ICU. All other aspects of care were dictated by the clinical team. Patients in the standard therapy (ST) group had intravenous fluids in accordance with the routine practice of the unit. Patients were divided into the GDT and ST group dependant on availability of cardiac output monitors and allocation of nursing staff with training in GDT. Patients' data were collected prospectively in both groups.

MEASUREMENTS AND MAIN RESULTS

One hundred twenty-three patients received GDT compared with 141 patients in the ST group. Both groups received similar volumes of fluid (GDT, 2905 [1367] mL vs 2704 [1393] mL; P=.09). Incidence of AKI was reduced in the GDT group (n=8 [6.5%] vs n=28 [19.9%]; P=.002). The median duration of hospital stay was 6 (4) days in the GDT group vs 7 (8) days in the ST, P=.004.

CONCLUSION

Postoperative GDT in patients after cardiac surgery was associated with reduction in the incidence of AKI and a reduction in ICU and hospital duration of stay.

Authors+Show Affiliations

Cardiothoracic Intensive Care Unit, St Georges NHS Hospital Trust, London, United Kingdom. Electronic address: Rebekah.thomson@nhs.net.Cardiothoracic Intensive Care Unit, St Georges NHS Hospital Trust, London, United Kingdom.Department of Cardiac Surgery, St Georges NHS Hospital Trust, London, United Kingdom.Cardiothoracic Intensive Care Unit, St Georges NHS Hospital Trust, London, United Kingdom.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25060640

Citation

Thomson, Rebekah, et al. "Goal-directed Therapy After Cardiac Surgery and the Incidence of Acute Kidney Injury." Journal of Critical Care, vol. 29, no. 6, 2014, pp. 997-1000.
Thomson R, Meeran H, Valencia O, et al. Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury. J Crit Care. 2014;29(6):997-1000.
Thomson, R., Meeran, H., Valencia, O., & Al-Subaie, N. (2014). Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury. Journal of Critical Care, 29(6), 997-1000. https://doi.org/10.1016/j.jcrc.2014.06.011
Thomson R, et al. Goal-directed Therapy After Cardiac Surgery and the Incidence of Acute Kidney Injury. J Crit Care. 2014;29(6):997-1000. PubMed PMID: 25060640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury. AU - Thomson,Rebekah, AU - Meeran,Hanif, AU - Valencia,Oswaldo, AU - Al-Subaie,Nawaf, Y1 - 2014/06/23/ PY - 2014/03/10/received PY - 2014/06/05/revised PY - 2014/06/13/accepted PY - 2014/7/26/entrez PY - 2014/7/26/pubmed PY - 2015/3/7/medline KW - Acute kidney injury KW - Cardiac surgery KW - Goal-directed therapy SP - 997 EP - 1000 JF - Journal of critical care JO - J Crit Care VL - 29 IS - 6 N2 - OBJECTIVE: The purpose of this study was to assess the effect of goal-directed therapy (GDT), after cardiac surgery, on the incidence of acute kidney injury (AKI). DESIGN: This is a prospective observational study designed to achieve and maintain maximum stroke volume for 8 hours, in patients after cardiac surgery. SETTING: This is a single-center study in a 15-bedded cardiothoracic intensive care unit (ICU). PARTICIPANTS: Participants are patients after coronary artery bypass grafting and/or aortic valve surgery. INTERVENTIONS: Patients in the GDT group received cardiac output monitoring and fluid challenges targeting an increase in stroke volume by at least 10%. Stroke volume maximization was maintained for a period of 8 hours from admission to the ICU. All other aspects of care were dictated by the clinical team. Patients in the standard therapy (ST) group had intravenous fluids in accordance with the routine practice of the unit. Patients were divided into the GDT and ST group dependant on availability of cardiac output monitors and allocation of nursing staff with training in GDT. Patients' data were collected prospectively in both groups. MEASUREMENTS AND MAIN RESULTS: One hundred twenty-three patients received GDT compared with 141 patients in the ST group. Both groups received similar volumes of fluid (GDT, 2905 [1367] mL vs 2704 [1393] mL; P=.09). Incidence of AKI was reduced in the GDT group (n=8 [6.5%] vs n=28 [19.9%]; P=.002). The median duration of hospital stay was 6 (4) days in the GDT group vs 7 (8) days in the ST, P=.004. CONCLUSION: Postoperative GDT in patients after cardiac surgery was associated with reduction in the incidence of AKI and a reduction in ICU and hospital duration of stay. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/25060640/Goal_directed_therapy_after_cardiac_surgery_and_the_incidence_of_acute_kidney_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(14)00242-1 DB - PRIME DP - Unbound Medicine ER -