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Modern hydroxyethyl starch and Acute Kidney Injury after cardiac surgery: a prospective multicenter cohort
S56
ORAL ABSTRACT PRESENTATIONS
three confidence intervals (CI) that would include true differences between mean AUCs with probability of 99% and type I error rate of 5% while within the equivalence range of ⫾15 ml kg1 h-1. Intention to treat analysis was used. Results. The means (99%CI) of EVLWI AUCs were in Cryst group 63.6 (58.4-68.8), in Gel group 61.7 (56.8-66.6), in HES group 65.2 (60.0-70.4) ml kg-1 h-1. The 99% CIs for the pairwise difference between mean EVLWI AUCs were fully within a prespecified equivalence range (Tabl.1). Cryst group-Gel group 1.85 (-9.33-5.63)
Cryst group-HES group
Gel group-HES group
-1.62 (-12.60-9.35)
-3.47 (-14.21-7.26)
Fluid balance on the POD1 was more positive in Cryst group 1920 [1333–3355] ml as compared to Gel group 740 [443–1460] ml and HES group 1055 [130–1640] ml (P¼0.0003). No difference was found regarding hemodynamics, the use of vasoactive and inotropic drugs. Blood loss, erythrocytes transfusion, and the incidence of adverse events were not different between the groups. Conclusion. Balanced crystalloid, 4% gelatin, and 6% HES 130/0.42 within goal-directed volume replacement showed equivalence with regard to extravascular lung water content in CABG patients despite more requirements in crystalloid. OP-160 Modern hydroxyethyl starch and Acute Kidney Injury after cardiac surgery: a prospective multicenter cohort 1
2
2
2
3
Vives M , Callejas R , Duque P , Echarri G , Hernandez A , Sabate A1, Bes M2 Monedero P2on behalf of the "Grupo Espanol de Disfuncion Renal tras Cirugia Cardiaca" (GEDRCC2) 1
Hospital Universitari Bellvitge, University of Barcelona, 2Clinica Universidad de Navarra, University of Navarra, 3University Hospital of South Manchester NHS Trust
Background & Aim. Recent trials suggest that the use of i.v. hydroxyethyl starch (HES) solutions is associated with increased risk of acute kidney injury (AKI) in critically ill patients1,2. It is uncertain whether similar adverse effects occur in cardiac surgical patients. Our aim is to determine renal safety of 6% HES 130/0.4 used during and after cardiac surgery. Methodology. Multicenter prospective observational cohort study at 28 different hospitals and cardiac ICU. One thousand sixty seven consecutive patients with cardiopulmonary bypass surgery from 15th of September 2012 to 15th of December 2012 were included. Results. 1,067 patients were included in the analysis. 350 patients (32.8%) used 6% HES 130/0.4 intraoperatively and postoperatively. AKI after cardiac surgery was diagnosed in 385 of 1,076 patients (36%). Overall in-hospital mortality was 4.4% (47 of 1,067 patients). Adjustment variables were those known to be associated with risk of AKI. We included baseline characteristics of the patients, surgical procedure-related and treatment in the ICU-related variables. Those variables were the following: age, sex, BMI, baseline Left Ventricle ejection fraction, Preoperative cardiogenic shock, use of preoperative IABP, unstable angina, pulmonar HTN, HTN, Baseline hemoglobin, COPD, Diabetes, previous surgery, urgent surgery, peripheral arterial disease, hospital, Euroscore, Cleveland Score, use of diuretics 48h prior to surgery, intraoperative use of vasopressors, Type of surgery, CPB time, intraoperative minimum hemoglobin, intraoperative RBC transfusion, Chronic Kidney Disease, use of noradrenaline or adrenaline, use of postoperative IABP and reintervention in 48h postoperatively .
With multivariate logistic regression, however, the results of this study showed that intraoperative and postoperative use of 6% HES 130/0.4 (vs non-HES) did not significantly increase the risk of AKI (37.43% vs 35.43%; OR1.03, 95% confidence interval 0.74-1.43, p¼0.84) in the patients undergoing cardiac surgery. Propensity score matching confirmed that intraoperative and postoperative use of modern hydroxyethyl starch (vs non-HES) did not significantly increase the risk of AKI (n¼670, OR 1.02, 95% confidence interval 0.93-1.11, p¼0.63) and dialysis required (OR 1.002, 95% confidence interval 0.97-1.03, p¼0.83). Conclusion. The intraoperative and postoperative use of modern hydroxyethyl starch was not associated with an increase risk of AKI and RRT after cardiac surgery. REFERENCES 1. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New Engl J Med 2012;367:1901-11.2. 2. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. New Engl J Med 2012; 367:124-34. OP-161 Prophylaxis of postoperative nausea and vomiting (ponv) in fast-track cardiac anaesthesia Elham Hasheminejad University of Leipzig Objective. The aim of our study was to evaluate the efficacy of a PONV prophylaxis protocol (PPP) in fast-track cardiac anaesthesia. Methods. To perform this retrospective observational study, data were gathered from anaesthesia and PACU electronic reports, before and after implementation of PPP. A sample of at least 132 patients per group was calculated as necessary to achieve a 40% reduction in PONV. A standardized anaesthetic regimen was applied to all patients and they received piritramid 0,1mg/Kg upon arrival in PACU followed by immediate termination of anaesthesia. After implementation of PPP all patients received dexamethason 4 mg at the induction of anaesthesia and in PACU droperidol 1,25mg was injected to all women and those men who underwent thoracotomy. Those with a past history of PONV received ondansetron 4mg as well. Qualitative data were statistically analysed by X2 test and quantitative data by t student. Results are presented as mean (⫾SD) and percentage (po0.05). Results. Records of 313 patients (72% males/ 28% females) were studied, 154 cases before and 159 after PPP. The overall PONV incidence was 42% before vs statistically significant reduction to 5% after PPP. Pre-prophylaxis PONV incidence was higher in women with sternotomy, however it was similar in both genders with thoracotomy. Reduction of PONV incidence was statistically significant in all subgroups after implementation of prophylaxis protocol. PONV
Sternotomy (n¼ 226) M (n¼169)
F (n¼57)
Thoracotomy (n¼87) M (n¼56)
F (n¼31)
Pre-prophylaxis
21.3%
75%
63.3%
50%
Post-prophylaxis
4.5%
3.4%
3.8%
13.3%
p
0.001
0.000
0.000
0.035
ORAL ABSTRACT PRESENTATIONS
three confidence intervals (CI) that would include true differences between mean AUCs with probability of 99% and type I error rate of 5% while within the equivalence range of ⫾15 ml kg1 h-1. Intention to treat analysis was used. Results. The means (99%CI) of EVLWI AUCs were in Cryst group 63.6 (58.4-68.8), in Gel group 61.7 (56.8-66.6), in HES group 65.2 (60.0-70.4) ml kg-1 h-1. The 99% CIs for the pairwise difference between mean EVLWI AUCs were fully within a prespecified equivalence range (Tabl.1). Cryst group-Gel group 1.85 (-9.33-5.63)
Cryst group-HES group
Gel group-HES group
-1.62 (-12.60-9.35)
-3.47 (-14.21-7.26)
Fluid balance on the POD1 was more positive in Cryst group 1920 [1333–3355] ml as compared to Gel group 740 [443–1460] ml and HES group 1055 [130–1640] ml (P¼0.0003). No difference was found regarding hemodynamics, the use of vasoactive and inotropic drugs. Blood loss, erythrocytes transfusion, and the incidence of adverse events were not different between the groups. Conclusion. Balanced crystalloid, 4% gelatin, and 6% HES 130/0.42 within goal-directed volume replacement showed equivalence with regard to extravascular lung water content in CABG patients despite more requirements in crystalloid. OP-160 Modern hydroxyethyl starch and Acute Kidney Injury after cardiac surgery: a prospective multicenter cohort 1
2
2
2
3
Vives M , Callejas R , Duque P , Echarri G , Hernandez A , Sabate A1, Bes M2 Monedero P2on behalf of the "Grupo Espanol de Disfuncion Renal tras Cirugia Cardiaca" (GEDRCC2) 1
Hospital Universitari Bellvitge, University of Barcelona, 2Clinica Universidad de Navarra, University of Navarra, 3University Hospital of South Manchester NHS Trust
Background & Aim. Recent trials suggest that the use of i.v. hydroxyethyl starch (HES) solutions is associated with increased risk of acute kidney injury (AKI) in critically ill patients1,2. It is uncertain whether similar adverse effects occur in cardiac surgical patients. Our aim is to determine renal safety of 6% HES 130/0.4 used during and after cardiac surgery. Methodology. Multicenter prospective observational cohort study at 28 different hospitals and cardiac ICU. One thousand sixty seven consecutive patients with cardiopulmonary bypass surgery from 15th of September 2012 to 15th of December 2012 were included. Results. 1,067 patients were included in the analysis. 350 patients (32.8%) used 6% HES 130/0.4 intraoperatively and postoperatively. AKI after cardiac surgery was diagnosed in 385 of 1,076 patients (36%). Overall in-hospital mortality was 4.4% (47 of 1,067 patients). Adjustment variables were those known to be associated with risk of AKI. We included baseline characteristics of the patients, surgical procedure-related and treatment in the ICU-related variables. Those variables were the following: age, sex, BMI, baseline Left Ventricle ejection fraction, Preoperative cardiogenic shock, use of preoperative IABP, unstable angina, pulmonar HTN, HTN, Baseline hemoglobin, COPD, Diabetes, previous surgery, urgent surgery, peripheral arterial disease, hospital, Euroscore, Cleveland Score, use of diuretics 48h prior to surgery, intraoperative use of vasopressors, Type of surgery, CPB time, intraoperative minimum hemoglobin, intraoperative RBC transfusion, Chronic Kidney Disease, use of noradrenaline or adrenaline, use of postoperative IABP and reintervention in 48h postoperatively .
With multivariate logistic regression, however, the results of this study showed that intraoperative and postoperative use of 6% HES 130/0.4 (vs non-HES) did not significantly increase the risk of AKI (37.43% vs 35.43%; OR1.03, 95% confidence interval 0.74-1.43, p¼0.84) in the patients undergoing cardiac surgery. Propensity score matching confirmed that intraoperative and postoperative use of modern hydroxyethyl starch (vs non-HES) did not significantly increase the risk of AKI (n¼670, OR 1.02, 95% confidence interval 0.93-1.11, p¼0.63) and dialysis required (OR 1.002, 95% confidence interval 0.97-1.03, p¼0.83). Conclusion. The intraoperative and postoperative use of modern hydroxyethyl starch was not associated with an increase risk of AKI and RRT after cardiac surgery. REFERENCES 1. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New Engl J Med 2012;367:1901-11.2. 2. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. New Engl J Med 2012; 367:124-34. OP-161 Prophylaxis of postoperative nausea and vomiting (ponv) in fast-track cardiac anaesthesia Elham Hasheminejad University of Leipzig Objective. The aim of our study was to evaluate the efficacy of a PONV prophylaxis protocol (PPP) in fast-track cardiac anaesthesia. Methods. To perform this retrospective observational study, data were gathered from anaesthesia and PACU electronic reports, before and after implementation of PPP. A sample of at least 132 patients per group was calculated as necessary to achieve a 40% reduction in PONV. A standardized anaesthetic regimen was applied to all patients and they received piritramid 0,1mg/Kg upon arrival in PACU followed by immediate termination of anaesthesia. After implementation of PPP all patients received dexamethason 4 mg at the induction of anaesthesia and in PACU droperidol 1,25mg was injected to all women and those men who underwent thoracotomy. Those with a past history of PONV received ondansetron 4mg as well. Qualitative data were statistically analysed by X2 test and quantitative data by t student. Results are presented as mean (⫾SD) and percentage (po0.05). Results. Records of 313 patients (72% males/ 28% females) were studied, 154 cases before and 159 after PPP. The overall PONV incidence was 42% before vs statistically significant reduction to 5% after PPP. Pre-prophylaxis PONV incidence was higher in women with sternotomy, however it was similar in both genders with thoracotomy. Reduction of PONV incidence was statistically significant in all subgroups after implementation of prophylaxis protocol. PONV
Sternotomy (n¼ 226) M (n¼169)
F (n¼57)
Thoracotomy (n¼87) M (n¼56)
F (n¼31)
Pre-prophylaxis
21.3%
75%
63.3%
50%
Post-prophylaxis
4.5%
3.4%
3.8%
13.3%
p
0.001
0.000
0.000
0.035