The Effect of Preoperative Creatinine Clearances on Postoperative Oxygenation in Coronary Artery Bypass Grafting: A Cohort Study
-
Fardin Yousefshahi
,
Khosro Barkhordari
,
Leila Mahdifar
,
Abbas Salehiomran
,
Hossein Majedi
,
Jayran Zebardast
Abstract
End-stage kidney disease has a high prevalence in patients undergone Coronary Artery Bypass Grafting (CABG) and could cause a wide spectrum of morbidities, due to deep water and electrolyte or acid-base impairments. The aim of this study was to assess the effect of low Creatinine Clearances (ClCr) on arterial oxygenation defect, as common post-CABG morbidity. The study was conducted as a prospective cohort, the pure on pump CABG patients were grouped based on their preoperative ClCr to groups A (ClCr≥60) and B (ClCr<60). Postoperatively, the PaO2/FiO2 values in 1 hour after ICU admission and 4 hours after extubation, intubation time duration, duration of ICU stay and high concentration oxygen demand were compared. Among 229 patients who remain in the study, 121 were in group A, and 108 in B group. Except for age, weight, height, BMI, and pump time, other demographic and independent variables were similar between two groups. The higher values of PaO2/FiO2 and PaO2, 1 hour after ICU admission and 4 hours after extubation in group B, were not statistically significant, while SpO2 value, 1 hour after ICU admission was higher in group B (98.19±1.37) in compare with group A (97.78±1.57) (P=0.040). Intubation time duration (10.85 in A vs. 12.79 in B; P=0.306), duration of ICU stay (39.04 in A vs. 43.09 in B; P=0.114) and high concentration oxygen demand (2.5% in A vs. 3.8% in B; P=0.089) were similar between groups of study. Lower Preoperative ClCr values do not deteriorate post-CABG arterial oxygenation.
Arom KV, Emery RW, Petersen RJ, Schwartz M. Cost-effectiveness and predictors of early extubation. Ann Thorac Surg. 1995;60(1):127-32.
Atabai K, Matthay MA. The pulmonary physician in critical care. 5: Acute lung injury and the acute respiratory distress syndrome: definitions and epidemiology. Thorax. 2002;57(5):452-8.
Baghban M, Paknejad O, Yousefshahi F, Moghadam KG, Bina P, Sadeh SS. Hospital-Acquired Pneumonia in Patients Undergoing Coronary Artery Bypass Graft; Comparison of the Center for Disease Control Clinical Criteria With Physicians’ Judgment. Anesthesiology and pain medicine. 2014;4(3).
Vakili M, Shirani S, Paknejad O, Yousefshahi F. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture. Acta Medica Iranica. 2015;53(1):51-6.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319-23.
Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1334-49.
Mutwali A, Glynn LG, Reddan D. Management of ischemic heart disease in patients with chronic kidney disease. Am J Cardiovasc Drugs. 2008;8(4):219-31.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):S112-9.
Burke JF, Jr., Francos GC, Moore LL, Cho SY, Lasker N. Accelerated atherosclerosis in chronic-dialysis patients--another look. Nephron. 1978;21(4):181-5.
Najafi M, Goodarzynejad H, Karimi A, Ghiasi A, Soltaninia H, Marzban M, et al. Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery? J Thorac Cardiovasc Surg. 2009;137(2):304-8.
VI. Causes of death in ESRD. Am J Kidney Dis. 1999;34(2 Suppl 1):S87-94.
V. Patient mortality and survival in ESRD. Am J Kidney Dis. 1999;34(2 Suppl 1):S74-86.
Bagdade J, Casaretto A, Albers J. Effects of chronic uremia, hemodialysis, and renal transplantation on plasma lipids and lipoproteins in man. J Lab Clin Med. 1976;87(1):38-48.
Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med. 1998;339(12):799-805.
Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290(13):697-701.
Yousefshahi F, Bashirzadeh M, Abdollahi M, Mojtahedzadeh M, Salehiomran A, Jalali A, et al. Effect of hypertonic saline infusion versus normal saline on serum NGAL and cystatin C levels in patients undergoing coronary artery bypass graft. The Journal of Tehran University Heart Center. 2013;8(1):21.
Barkhordari K, Karimi A, Shafiee A, Soltaninia H, Khatami MR, Abbasi K, et al. Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase-associated lipocalin. Journal of cardiothoracic surgery. 2011;6(1):8.
Mazandarani M, Yousefshahi F, Abdollahi M, Hamishehkar H, Barkhordari K, Boroomand MA, et al. Comparison of hypertonic saline versus normal saline on cytokine profile during CABG. DARU Journal of Pharmaceutical Sciences. 2012;20(1):49.
Yousefshahi F, Yasseri AMF, Barkhordari K, Amini M, Omran AS, Rezaeihemami M, et al. Incidence and complications of acute kidney injury following coronary artery bypass graft: a retrospective cohort study. Iranian Journal of Kidney Disease. 2015;9(2):113-8.
Yousefshahi F, Barkhordari K, Movafegh A, Tavakoli V, Paknejad O, Bina P, et al. A New Method for Extubation: Comparison between Conventional and New Methods. The Journal of Tehran University Heart Center. 2015;7(3):121-7.
Thakar CV, Worley S, Arrigain S, Yared J-P, Paganini EP. Improved survival in acute kidney injury after cardiac surgery. American Journal of Kidney Diseases. 2007;50(5):703-11.
van Straten AH, Hamad MAS, van Zundert AA, Martens EJ, Schönberger JP, de Wolf AM. Preoperative renal function as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. The Journal of thoracic and cardiovascular surgery. 2009;138(4):971-6.
Huen SC, Parikh CR. Predicting acute kidney injury after cardiac surgery: a systematic review. The Annals of thoracic surgery. 2012;93(1):337-47.
Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal medicine. 2013;3(3):178-99.
Légaré J, Hirsch G, Buth K, MacDougall C, Sullivan J. Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting. European journal of cardio-thoracic surgery. 2001;20(5):930-6.
Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. CHEST Journal. 2008;133(3):713-21.
Hoste E, Cruz D, Davenport A, Mehta R, Piccinni P, Tetta C, et al. The epidemiology of cardiac surgery-associated acute kidney injury. The International journal of artificial organs. 2008;31(2):158-65.
Parolari A, Alamanni F, Gherli T, Bertera A, Dainese L, Costa C, et al. Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamics. The Annals of thoracic surgery. 1999;67(5):1320-7.
Haase M, Bellomo R, Story D, Letis A, Klemz K, Matalanis G, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury. Nephrology Dialysis Transplantation. 2012;27(1):153-60.
Kabon B, Nagele A, Reddy D, Eagon C, Fleshman JW, Sessler DI, et al. Obesity decreases perioperative tissue oxygenation. The Journal of the American Society of Anesthesiologists. 2004;100(2):274-80.
Chalhoub V, Yazigi A, Sleilaty G, Haddad F, Noun R, Madi-Jebara S, et al. Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. European journal of anaesthesiology. 2007;24(03):283-8.
Gersak B, Sutlic Z, editors. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time. Heart Surg Forum; 2002.
| Files | ||
| Issue | Vol 56, No 12 (2018) | |
| Section | Articles | |
| Keywords | ||
| CABG Creatinine clearances PaO2/FiO2 Oxygenation | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
