Association between intraoperative plantar regional oxygen saturation and acute kidney injury after cardiac surgery

• Published in: Journal of clinical monitoring and computing Vol. 37; no. 2; pp. 525 - 540
• Main Authors: Ju, Jae-Woo, Yoo, Sol Ji, Park, Dongnyeok, Bae, Jinyoung, Lee, Seohee, Nam, Karam, Cho, Youn Joung, Lee, Hyung-Chul, Jeon, Yunseok
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.04.2023; Springer Nature B.V
• Subjects: Acute Kidney Injury - etiology; Anesthesiology; Blood pressure; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Critical Care Medicine; Health Sciences; Heart surgery; Humans; Infrared spectra; Intensive; Kidneys; Medicine; Medicine & Public Health; Monitoring, Intraoperative - methods; Near infrared radiation; Original Research; Oxygen; Oxygen content; Oxygen Saturation; Regression analysis; Retrospective Studies; Statistics for Life Sciences; Surgery; Near infrared spectroscopy; Prevention; Cardiac surgery; Acute kidney injury; Foot
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-022-00917-y

Acute kidney injury (AKI) is one of the most common complications after cardiac surgery, associated with increased mortality and morbidity. Near-infrared spectroscopy (NIRS) continuously measures regional oxygen saturation(rSO 2 ) in real-time. This exploratory retrospective study aimed to investigate the association between intraoperative plantar rSO 2 and postoperative AKI in cardiac surgery patients. Between August 2019 and March 2021, 394 patients were included. Plantar and cerebral rSO 2 were monitored using NIRS intraoperatively. The primary outcome was AKI within 7 postoperative days. The nonlinear association between plantar rSO 2 , cerebral rSO 2 , and mean arterial blood pressure (MBP) and AKI was assessed, and plantar rSO 2 <45% was related to an increased risk of AKI. Multivariable logistic regression analyses revealed that longer duration and higher area under the curve below plantar rSO 2 <45% and MBP<65 mmHg were more likely to be associated with increased odds of AKI. In additional multivariable regression analyses, association between plantar rSO 2 <45% and AKI was still maintained after adjusting the duration or AUC of MBP<65 mmHg as a covariate. Cerebral rSO 2 levels were not associated with AKI. Independent of MAP, intraoperative plantar rSO 2 was associated with AKI after cardiac surgery. However, intraoperative cerebral rSO 2 was not associated with AKI. Intraoperative plantar rSO 2 monitoring may be helpful in preventing AKI.