Seminars in Cardiothoracic and Vascular Anesthesia

 

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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 11, No. 4, 265-268 (2007)
DOI: 10.1177/1089253207311141

Perioperative Renal Failure: Hypoperfusion During Cardiopulmonary Bypass?

Marco Ranucci, MD

Department of Anestesia and Intensive Care, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy, cardioanestesia{at}virgilio.it

Acute renal failure is one of the most frequent and life-threatening complications after cardiac surgery. There is a recent growing deal of information suggesting that during the time of cardiopulmonary bypass kidneys may suffer from an imbalance between oxygen supply and oxygen needs. A low hematocrit during cardiopulmonary bypass is associated with an increase risk of acute renal failure, mainly due to a low oxygen delivery. An inadequate oxygen delivery during cardiopulmonary bypass is associated with lactate production, and under normothermic conditions, hyperlactatemia appears for an oxygen delivery below 260 mL min– 1 m–2. The risk of acute renal failure significantly increases for an oxygen delivery approximately at the same value (272 mL min–1 m– 2). During cardiopulmonary bypass, the pump flow should be coupled with the hematocrit to avoid falling below this critical oxygen delivery.

Key Words: cardiopulmonary bypass • acute renal failure • oxygen delivery


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