1. Assessing the renal macro-and microcirculation during cardiopulmonary bypass: A pre-clinical ovine model.
- Author
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May C.N., Hood S., Iguchi N., Marino B., Cochrane A.D., Lankadeva Y.R., Evans R.G., May C.N., Hood S., Iguchi N., Marino B., Cochrane A.D., Lankadeva Y.R., and Evans R.G.
- Abstract
Objectives: Acute kidney injury (AKI) develops in ~30% of patients following cardiac surgery on cardiopulmonary bypass (CPB). There are no interventions to prevent post-operative AKI, because its pathophysiology remains unclear. Our aims are (1) to determine the effects of CPB on the renal macro-and micro-circulation and (2) to determine the effects of altering pump flow on global and regional-kidney perfusion and oxygenation during CPB. Method(s): We implanted a flow probe on the renal artery and laser Doppler/oxygen-sensing probes in the cortex and medulla in sheep (N = 10). After baseline recordings in conscious sheep, animals were anesthetized, then placed on CPB with inspired oxygen fraction (FiO2) maintained at 0.6. From a baseline level of 80 mL/kg/min, pump flow was altered to 60, 80 and 100 mL/kg/min in random order. Result(s): During CPB, renal blood flow (RBF; 287 +/- 21 to 109 +/- 19 mL/ min), medullary perfusion (720 +/- 127 to 222 +/- 42 BPU) and medullary oxygenation (48 +/- 5 to 22 +/- 7 mmHg) were all reduced, compared with conscious sheep. Cortical oxygenation increased during CPB (46 +/- 3 to 70 +/- 17 mmHg), despite reduced perfusion (1954 +/- 378 to 872 +/- 112 BPU). Reducing pump flow exacerbated medullary hypoxia (to 11 +/- 3 mmHg), while increasing pump flow tended to improve medullary oxygenation (to 29 +/- 7 mmHg). Conclusion(s): CPB had detrimental effects on RBF, medullary and cortical perfusion and medullary oxygenation. Cortical oxygenation was maintained by the high FiO2. Medullary hypoxia may be a crucial mediator of post-CPB AKI. Thus, avoiding medullary hypoxia, by optimizing perfusion conditions on CPB, may be a feasible strategy to mitigate post-operative AKI.
- Published
- 2019