PREVENTION OF ACUTE KIDNY INJURY USING CEREBRAL OXIMETRY DURING CARDIOPULMONARY BYPASS IN CABG PATIENTS
Keywords:Acute kidney injury, Cardiac surgery, Cerebraloximetry, Coronary artery bypass grafting, Near infrared spectroscopy
Objective: To determine the role of cerebral oximetry in addition to conventional monitors during cardio-pulmonary bypass in coronary artery bypass grafting (CABG) patients for prevention of acute kidney injury.
Study Design: Randomized controlled trial.
Place and Duration of Study: Six months study at department of cardiac anesthesia, Armed Forces institute of Cardiology and National institute of heart diseases, Rawalpindi.
Methodology: We prospectively analyzed the collected data of 100 adult patients with normal. Preoperative renal function who underwent isolated coronary artery bypass grafting (CABG) from June 2018 to Dec 2018. Patients were randomly allocated into two groups i.e., control group A (n=50) and test group B (n=50). Patients in group A were monitored for organ perfusion using standard tool i.e., MAP, SvO2, pump flow and lactate levels while patients in group B were monitored with near infrared spectroscopy (NIRS) in addition to standard monitoring. Kidney injury was assessed according to the Acute Kidney Injury Network criteria. Cerebral oximetery, hemoglobin and other important variables were measured every hour intra-operatively and for the first 24 hours postoperatively.
Results: AKI developed less in cerebral oximetery group as compare to control group i.e., 5 (10%) vs. 15 (30%). In this study, the rate of postoperative AKI development was high in patients with a low values of cerebral oximetry (SrcO2).
Conclusion: This randomized controlled trial showed that a lower cerebral oximetery is correlated well with AKI after CABG patients. Our study concludes that cerebral oximetry in addition to conventional perfusion monitoring may help to prevent AKI after cardiac surgery.