AKI
Conditions
Keywords
transesophagel echocardiography cardiac surgery kidney function
Brief summary
The purpose of this study is to better understand if transesophageal echocardiography during cardiac surgery can predict problems with kidney function after cardiac surgery.
Detailed description
Informed consent will be obtained prior to surgery. Preoperative demographic and baseline clinical data will be collected. We will assess the patient's risk of postoperative AKI using the validated Cleveland clinic score based on preoperative risk factors and calculate the European System Operative Score Risk Evaluation score (EuroSCORE II). After standard anesthesia induction and intubation, a TEE probe will be inserted by a cardiac anesthesiologist, who is certified in intraoperative echocardiography. We will use a standard ultrasound machine (EPIQ 7 Philips;Philips, Bothell, WA). Images of the right or left kidney along with Doppler flow and velocities will be obtained prior to cardiopulmonary bypass (CPB), after CPB, and after chest closure. Images of the portal vein with Doppler flow and velocity will be obtained prior to CPB, after CPB, and after chest closure. Vitals signs and hemodynamic data will be collected concurrently during these times. (See Data Sheet) Concurrent ECG will be obtained to identify the phases of the cardiac cycle. Mean arterial pressure (MAP) will be maintained within 20% of baseline MAP with bolus or continuous infusion of vasopressors (phenylephrine, norepinephrine, epinephrine, vasopressin, ephedrine). Cardiopulmonary bypass management will be standard, with target systemic blood flow of 2.4L/min/m2. Postoperative data will include urine output, serum creatinine, calculated GFR (using Modification of Diet in Renal Disease \[MDRD\] method) hospital and ICU length of stay, and 30-day mortality.
Interventions
None listed
Sponsors
University of Chicago
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inclusion criteria are patients \>18 years old getting elective cardiac surgery with the use of cardiopulmonary bypass at the University of Chicago Medical Center.
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Portal vein pulsatility | intra-operative measurement | Pulsed-wave Doppler measurement of portal vein flow and portal hypertension |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Renal resistance index | intra-operative measurement | A sonographic index to assess for renal arterial disease measured via pulsed-wave Doppler |
| ICU length of stay | 30 days post-operation | Length of ICU stay at any point for 30 days post-operation will be recorded |
| Hospital length of stay | 30 days post-operation | Length of Hospital stay up to 30 days post-operation will be recorded |
| 30-day mortality | 30 day post-operation | Standard measure post |
Countries
United States
Outcome results
None listed