546816 research-article2014
PRF0010.1177/0267659114546816PerfusionCommentary
Commentary
Commentary on: Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass: an evidence-based review
Perfusion 2015, Vol. 30(1) 33 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114546816 prf.sagepub.com
Presenter: DM Long
MR. DANIEL FITZGERALD (Boston, Massachusetts): We tend to think urinary output is a surrogate of good renal function, but, in fact, it is how the kidney alters the filtrate. Are you aware of any good papers comparing urine chemistry to blood chemistry intraoperatively to look at when the injury might occur or when that mechanism is affected? MR. DENNIS M. LONG (Mt. Prospect, Illinois): There is a prospective observational 2010 study that was published [Aregger F, Pilop C, Uehlinger DE, et al. Urinary proteomics before and after extracorporeal circulation in patients with and without acute kidney injury. J Thorac Cardiovasc Surg 2010; 139: 692-700.]. It reported biomarkers of kidney injury in the urine of patients as they underwent cardiopulmonary bypass. They reported the greatest period of insult was during bypass and this issue has been studied in animal models as well. MS. VANESSA FARNETI (Hoboken, New Jersey): It is interesting that you addressed the method and the charting of pressures and other parameters and how it impacts the research. How do you think electronic charting is going to impact perfusion research in the future as more teams begin using this technology? MR. LONG: I think electronic charting is going to change it dramatically. There was a recent study by Haase and coworkers where they were looking at mean arterial pressure and kidney injury and blood transfusion [Haase M, Bellomo R, Story D, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute
kidney injury. Nephrol Dial Transplant 2012; 27: 153-160.]. During the study period, they had transitioned to electronic charting and there was this dramatic change. They suddenly went from having a limited number of data sets to having thousands of data points. I think this is going to change perfusionists’ practice by recording all flows at all times. We only tend to chart the best things when using handwritten charts. I think it will change clinical practice and drive it forward in areas where we may need to improve. MR. JUSTIN RESLEY (Evans, Georgia): Is there anything that you found with regard to pulsatility in any of the papers you reviewed? MR. LONG: It is really a challenging question and I did not address that in detail in the presentation. The effect of pulsatility depends on how you are creating the pulse - for example, the equipment being used to create the pulse, whether you are you using an intra-aortic balloon pump to create the pulse, whether you are pumping blood with a roller or centrifugal pump through a membrane oxygenator. The study end points found in the literature are mixed and some of the studies are retrospective in design. It apparently has become more popular in Europe to use pulsatile perfusion and Americans have not really embraced it. Perhaps this is due to some of the challenges. I think there are other areas to focus on. Consider the fact that patients supported by continuous flow left ventricular assist devices live for years with normal renal function afterwards. I think we might be stressing a little too much on the typical two-hour timeframe the patient is supported by cardiopulmonary bypass.
This commentary is taken from the discussion that followed the presentation of the previous paper at the 35th Annual Seminar of the American Academy of Cardiovascular Perfusion. Although the paper has been through Perfusion’s stringent peer-review process, the commentary is a transcript of the discussion, edited for clarity, and the views expressed in the commentary are those of the commentators and do not necessarily represent, and should not be attributed to, the journal Perfusion, the Editors, or the Publisher, SAGE.
Downloaded from prf.sagepub.com at RUTGERS UNIV on June 2, 2015
PRF0010.1177/0267659114546816PerfusionCommentary
Commentary
Commentary on: Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass: an evidence-based review
Perfusion 2015, Vol. 30(1) 33 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114546816 prf.sagepub.com
Presenter: DM Long
MR. DANIEL FITZGERALD (Boston, Massachusetts): We tend to think urinary output is a surrogate of good renal function, but, in fact, it is how the kidney alters the filtrate. Are you aware of any good papers comparing urine chemistry to blood chemistry intraoperatively to look at when the injury might occur or when that mechanism is affected? MR. DENNIS M. LONG (Mt. Prospect, Illinois): There is a prospective observational 2010 study that was published [Aregger F, Pilop C, Uehlinger DE, et al. Urinary proteomics before and after extracorporeal circulation in patients with and without acute kidney injury. J Thorac Cardiovasc Surg 2010; 139: 692-700.]. It reported biomarkers of kidney injury in the urine of patients as they underwent cardiopulmonary bypass. They reported the greatest period of insult was during bypass and this issue has been studied in animal models as well. MS. VANESSA FARNETI (Hoboken, New Jersey): It is interesting that you addressed the method and the charting of pressures and other parameters and how it impacts the research. How do you think electronic charting is going to impact perfusion research in the future as more teams begin using this technology? MR. LONG: I think electronic charting is going to change it dramatically. There was a recent study by Haase and coworkers where they were looking at mean arterial pressure and kidney injury and blood transfusion [Haase M, Bellomo R, Story D, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute
kidney injury. Nephrol Dial Transplant 2012; 27: 153-160.]. During the study period, they had transitioned to electronic charting and there was this dramatic change. They suddenly went from having a limited number of data sets to having thousands of data points. I think this is going to change perfusionists’ practice by recording all flows at all times. We only tend to chart the best things when using handwritten charts. I think it will change clinical practice and drive it forward in areas where we may need to improve. MR. JUSTIN RESLEY (Evans, Georgia): Is there anything that you found with regard to pulsatility in any of the papers you reviewed? MR. LONG: It is really a challenging question and I did not address that in detail in the presentation. The effect of pulsatility depends on how you are creating the pulse - for example, the equipment being used to create the pulse, whether you are you using an intra-aortic balloon pump to create the pulse, whether you are pumping blood with a roller or centrifugal pump through a membrane oxygenator. The study end points found in the literature are mixed and some of the studies are retrospective in design. It apparently has become more popular in Europe to use pulsatile perfusion and Americans have not really embraced it. Perhaps this is due to some of the challenges. I think there are other areas to focus on. Consider the fact that patients supported by continuous flow left ventricular assist devices live for years with normal renal function afterwards. I think we might be stressing a little too much on the typical two-hour timeframe the patient is supported by cardiopulmonary bypass.
This commentary is taken from the discussion that followed the presentation of the previous paper at the 35th Annual Seminar of the American Academy of Cardiovascular Perfusion. Although the paper has been through Perfusion’s stringent peer-review process, the commentary is a transcript of the discussion, edited for clarity, and the views expressed in the commentary are those of the commentators and do not necessarily represent, and should not be attributed to, the journal Perfusion, the Editors, or the Publisher, SAGE.
Downloaded from prf.sagepub.com at RUTGERS UNIV on June 2, 2015
