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Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making.


ABSTRACT:

Objectives

The authors sought to (1) characterize the rationale underpinning anesthesiologists' use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which anesthesiologists would most value a detailed, evidence-based review.

Design

Survey of perioperative practice in adult patients undergoing cardiac surgery.

Setting

Online survey.

Participants

Members of the Society of Cardiovascular Anesthesiologists (SCA).

Interventions

None.

Measurements & main results

The survey was distributed to more than 2,000 SCA members and completed in whole or in part by 202 respondents. Selection of target intraoperative blood pressure (and relative hypotension avoidance) was the strategy most frequently reported to reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most respondents believed the evidence supporting an effect on renal injury of intraoperative target blood pressure during cardiac surgery was of high or moderate quality. Other factors, including a specific nonrenal rationale, surgeon preference, department- or institution-level decisions, tradition, or habit, also frequently were reported to affect decision making across queried strategies. Potential renoprotective strategies most frequently requested for inclusion in a subsequent detailed, evidence-based review were intraoperative target blood pressure and choice of vasopressor agent to achieve target pressure.

Conclusions

A large number of perioperative strategies are believed to variably affect renal injury in adult patients undergoing cardiac surgery, with wide variation in perceived quality of evidence for a renal effect of these strategies.

SUBMITTER: McIlroy DR 

PROVIDER: S-EPMC9933995 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making.

McIlroy David R DR   Roman Bennett B   Billings Frederic T FT   Bollen Bruce A BA   Fox Amanda A   Geube Mariya M   Liu Hong H   Shore-Lesserson Linda L   Zarbock Alexander A   Shaw Andrew D AD  

Journal of cardiothoracic and vascular anesthesia 20210206 7


<h4>Objectives</h4>The authors sought to (1) characterize the rationale underpinning anesthesiologists' use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which anesthesiologists would most value a detailed, evidence-based review.<h4>Design</h4>Survey of p  ...[more]

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