Targeted Blood-pressure Management and Acute Kidney Injury After Coronary Artery Bypass Surgery
Impact of Targeted Blood-pressure Management on Incidence of Acute Kidney Injury After Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial
Peking University First Hospital
612 participants
Aug 14, 2018
INTERVENTIONAL
Conditions
Summary
Acute renal injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. It is now realized that intraoperative hypotension is an important risk factor for the development of AKI. In a recent randomized controlled trial of patients undergoing major noncardiac surgery, intraoperative individualized blood-pressure management reduced the incidence of postoperative organ dysfunction. The investigators hypothesize that, for patients undergoing off-pump CABG, targeted blood-pressure management during surgery may also reduce the incidence of postoperative AKI.
Eligibility
Inclusion Criteria2
- Age ≥ 50 years;
- Scheduled to undergo off-pump CABG surgery.
Exclusion Criteria7
- Refuse to participate;
- Untreated or uncontrolled severe hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg);
- Chronic kidney disease with a glomerular filtration rate < 30 ml/min/1.73 m2 or end-stage renal disease requiring renal-replacement therapy;
- Inability to communicate during the preoperative period because of coma, profound dementia, language barrier, or end-stage disease;
- Requirement of vasopressors/inotropics to maintain blood pressure before surgery;
- Second or emergency surgery;
- Expected survival of less than 24 hours.
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Interventions
Prophylactic norepinephrine infusion is started before anesthetic induction and maintained throughout surgery. The target is to maintain systolic blood pressure at 110 mmHg or higher.
Phenylephrine (25-50 ug) is injected or vasopressors is infused only when necessary. The target is to maintain systolic blood pressure at 90 mmHg or higher during surgery.
Locations(1)
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NCT03629418