Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making

Abstract

Objectives: The authors sought to (1) characterize the rationale underpinning anesthesiologists' use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which anesthesiologists would most value a detailed, evidence-based review.

Design: Survey of perioperative practice in adult patients undergoing cardiac surgery.

Setting: Online survey.

Participants: Members of the Society of Cardiovascular Anesthesiologists (SCA).

Interventions: None.

Measurements & main results: The survey was distributed to more than 2,000 SCA members and completed in whole or in part by 202 respondents. Selection of target intraoperative blood pressure (and relative hypotension avoidance) was the strategy most frequently reported to reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most respondents believed the evidence supporting an effect on renal injury of intraoperative target blood pressure during cardiac surgery was of high or moderate quality. Other factors, including a specific nonrenal rationale, surgeon preference, department- or institution-level decisions, tradition, or habit, also frequently were reported to affect decision making across queried strategies. Potential renoprotective strategies most frequently requested for inclusion in a subsequent detailed, evidence-based review were intraoperative target blood pressure and choice of vasopressor agent to achieve target pressure.

Conclusions: A large number of perioperative strategies are believed to variably affect renal injury in adult patients undergoing cardiac surgery, with wide variation in perceived quality of evidence for a renal effect of these strategies.

Keywords: acute kidney injury; perioperative; thoracic surgery.

Figure 1

Response options for Questions 1–11 A and B of the survey

Figure 2

Respondent demographics by a) geographic location of practice, b) type of practice, c) level of training, and d) annual case volume of cardiac surgical procedures

Figure 3

Reno-protective strategies (proportion of respondents and 95% CI’s) for which respondents would most value a detailed evidence-based review