Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury.
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.
['Thomson|Rebekah|R|', 'Meeran|Hanif|H|', 'Valencia|Oswaldo|O|', 'Al-Subaie|Nawaf|N|']
D058186:Acute Kidney Injury D000368:Aged D000369:Aged, 80 and over D000465:Algorithms D001021:Aortic Valve D002302:Cardiac Output D002985:Clinical Protocols D001026:Coronary Artery Bypass D005260:Female D005440:Fluid Therapy D006801:Humans D015994:Incidence D007262:Infusions, Intravenous D007902:Length of Stay D008297:Male D008875:Middle Aged D008991:Monitoring, Physiologic D011446:Prospective Studies D013318:Stroke Volume
Goal-directed therapy Cardiac surgery Acute kidney injury