Japanese Journal of Extra-Corporeal Technology
Online ISSN : 1884-5452
Print ISSN : 0912-2664
ISSN-L : 0912-2664
Volume 47 , Issue 1
Showing 1-4 articles out of 4 articles from the selected issue
Original Article
  • Yoshihito Wakamatsu, Keisuke Nakanishi, Satoshi Matsushita, Go Sato, H ...
    2020 Volume 47 Issue 1 Pages 8-14
    Published: 2020
    Released: April 02, 2020
    JOURNALS FREE ACCESS

    Early intervention can significantly improve patient outcomes in acute kidney injury (AKI). In children with underdeveloped kidneys, it takes longer than 24 hours for serum creatinine (sCr) to peak after AKI onset. Furthermore, even very subtle increases in sCr are associated with poor outcomes, making it more difficult to diagnose early AKI in pediatric cases.

    The urinary neutrophil gelatinase-associated lipocalin (NGAL) levels of 64 patients undergoing pediatric cardiac surgery using cardiopulmonary bypass from June 2018 to February 2019 were measured to evaluate NGAL as an accurate indicator of postoperative AKI.

    Sixteen patients (25%) developed AKI. The AKI group showed significantly higher Risk Adjustment in Congenital Heart Surgery (RACHS-1) scores (p=0.028) and a significantly longer operative time (p=0.048), cardiopulmonary bypass time (p=0.048), and ventilator use time (p<0.001) than the non-AKI group. After surgery, urinary NGAL was significantly higher in the AKI group with a median of 37.1ng/mL (11.1-148.3) against 5.6ng/mL (1.0-35.8) of the non-AKI group (p=0.021). Using a cut-off value of 11.9ng/mL, the area under the curve of urinary NGAL for predicting AKI was 0.69, the sensitivity was 75%, and the specificity was 44%.

    Higher RACHS-1 scores are associated with postoperative AKI. Urinary NGAL shows a moderate correlation with AKI diagnosis, and may be useful for predicting AKI early in the perioperative period.

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Original Articles
  • Yoshihito Wakamatsu, Keisuke Nakanishi, Satoshi Matsushita, Go Sato, H ...
    2020 Volume 47 Issue 1 Pages 15-21
    Published: 2020
    Released: April 02, 2020
    JOURNALS FREE ACCESS

    Early intervention can significantly improve patient outcomes in acute kidney injury (AKI). In children with underdeveloped kidneys, it takes longer than 24 hours for serum creatinine (sCr) to peak after AKI onset. Furthermore, even very subtle increases in sCr are associated with poor outcomes, making it more difficult to diagnose early AKI in pediatric cases.

    The urinary neutrophil gelatinase-associated lipocalin (NGAL) levels of 64 patients undergoing pediatric cardiac surgery using cardiopulmonary bypass from June 2018 to February 2019 were measured to evaluate NGAL as an accurate indicator of postoperative AKI.

    Sixteen patients (25%) developed AKI. The AKI group showed significantly higher Risk Adjustment in Congenital Heart Surgery (RACHS-1) scores (p=0.028) and a significantly longer operative time (p=0.048), cardiopulmonary bypass time (p=0.048), and ventilator use time (p<0.001) than the non-AKI group. After surgery, urinary NGAL was significantly higher in the AKI group with a median of 37.1ng/mL (11.1-148.3) against 5.6ng/mL (1.0-35.8) of the non-AKI group (p=0.021). Using a cut-off value of 11.9ng/mL, the area under the curve of urinary NGAL for predicting AKI was 0.69, the sensitivity was 75%, and the specificity was 44 %.

    Higher RACHS-1 scores are associated with postoperative AKI. Urinary NGAL shows a moderate correlation with AKI diagnosis, and may be useful for predicting AKI early in the perioperative period.

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  • Kohei Nagashima, Yuko Matsusaka, Natsuki Hajikano, Nao Kozaki, Yuichi ...
    2020 Volume 47 Issue 1 Pages 22-27
    Published: 2020
    Released: April 02, 2020
    JOURNALS FREE ACCESS

    [Objective]In minimally invasive cardiac surgery (MICS), leg ischemia is one of the known complications due to the femoral arterial cannulation. We routinely monitor distal leg perfusion based on the regional oxygen saturation(rSO2) using the near-infrared spectroscopy (NIRS) for the prevention of lower limb ischemia. In this study, we examined the impact of the tip design of the femoral arterial cannula on distal leg perfusion.

    [Methods]From April 2014 to September 2017, we performed 106 cases of right thoracotomy MICS with femoral arterial cannulation. We used a cannula with multiple side holes and no wire-reinforced tip in 52 patients (group C), and a cannula with few side holes and wire-reinforcement in 54 patients (group N). We adjusted for confounding variables using propensity score matching.

    [Results]The rate of drops in rSO2 value greater than 25% was significantly lower in group N than in group C (15.6% vs 60.0%;p=0.003). No significant difference was observed in other factors.

    [Conclusion]In addition to conventional prevention methods, using a wire-reinforced femoral arterial cannula may reduce the risk of lower limb ischemia in MICS.

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  • -- A two-center observational study -
    Hiroshi Mukaida, Satoshi Matsushita, Kohei Nagashima, Minoru Tabata, A ...
    2020 Volume 47 Issue 1 Pages 28-34
    Published: 2020
    Released: April 02, 2020
    JOURNALS FREE ACCESS

    Venous oxygen saturation (SvO2) poorly reflects regional oxygen supply-demand imbalance which suggests its limitations as an indicator of adequate perfusion during cardiopulmonary bypass (CPB). Recently, the role of oxygen delivery (DO2) in CPB has gained attention since studies have shown that maintaining sufficient DO2 is associated with reduced incidence of postoperative acute kidney injury (AKI). In this study, we investigated the relationship between AKI onset, SvO2 and DO2, and examined whether the limitations of SvO2 could be compensated by monitoring DO2.

    We enrolled adult patients (estimated glomerular filtration rate >60mL/min/1.73m2) who underwent open heart surgery using CPB at Juntendo University Hospital and Tokyo Bay Urayasu Ichikawa Medical Center between March 2017 and December 2018. Postoperative AKI was used as an index of optimal perfusion. The area under the curve (AUC<SvO2 75, AUC<DO2 i300)and cumulative time(Time<SvO2 75, Time<DO2 i300)below the cutoff threshold were calculated. Wilcoxon test, Chi-square test, and receiver operating characteristic (ROC) analysis were used to evaluate the relationship between intraoperative variables and postoperative AKI.

    Patients were stratified into AKI (n=191) and non-AKI groups (n=49). The AKI group had a larger AUC <DO2 i300 (450 vs 1103;p=0.025) and a longer Time<DO2 i300 (7.3 vs 16.3min;p=0.016), but AUC<SvO2 75 (42 vs 30;p=0.620) and Time<SvO2 75 (2.7 vs 3.7min;p=0.771) were not significantly different between the groups. The ROC analysis for AKI incidence showed significant difference between AUC values for Time<SvO2 75 and Time<DO2 i300 (0.098, p=0.028).

    In both groups, SvO2 was generally maintained at the usual safe range of 75% or more. However, DO2 i was significantly lower in the AKI group, suggesting that maintaining SvO2 above 75% does not prevent postoperative AKI. Maintaining DO2 i levels >300mL/min/m2, in addition to the standard SvO2 monitoring, as target for blood flow management can help ensure optimal perfusion during CPB.

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