Patient-specific susceptibility to the nadir oxygen delivery on cardiopulmonary bypass.

Authors

Martina Anguissola, Alessandro Barbaria, Roberto Ferrari, Ekaterina Baryshnikova, Giovanna Landi, Marco Ranucci

Published in

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. Oct 22, 2025. Epub Oct 22, 2025.

Abstract

Maintaining a nadir oxygen delivery ≥ 280 mL/min/m2 during cardiopulmonary bypass is a pillar of the goal-directed perfusion strategy in cardiac surgery. However, there are patients who develop a cardiac surgery associated acute kidney injury despite an adequate oxygen delivery and others who do not develop an acute kidney injury despite a low oxygen delivery. The present study aims to determine the independent factors associated with these 2 conditions. Methods: Post-hoc analysis of 2 previously published series.
the population size was 1,030 patients. Inability to maintain the target oxygen delivery was found in 35% of the patients, and the independent determinants were female gender, low creatinine clearance, low preoperative hematocrit and non-elective surgery. Acute kidney injury was found in 18.3% of the total patient population. Within the patients with a nadir oxygen delivery < 280 mL/min/m2 73% did not develop an acute kidney injury. These patients were younger, with a lower baseline serum creatinine, shorter cardiopulmonary bypass and lower peak lactate. Within the patients with a nadir oxygen delivery ≥ 280 mL/min/m2 13% developed an acute kidney injury: these patients were older, with a lower baseline hematocrit, land onger cardiopulmonary bypass.
preoperative anemia is the main determinant of a failing goal directed perfusion. In younger patients at short cardiopulmonary bypass may be possible to reduce the target oxygen delivery. Acute kidney injury in patients with a nadir oxygen delivery ≥ 280 mL/min/m2 is a relatively rare condition whose mechanisms remain to be elucidated.

PMID:
41124609
Bibliographic data and abstract were imported from PubMed on 23 Oct 2025.

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