The Effect Of Target-Orıented Lıquıd Therapy On The Development Of Acute Renal Faılure In Patıents Wıth Cardıac Surgery

The Effect Of Target-Orıented Lıquıd Therapy On The Development Of Acute Renal Faılure In Patıents Wıth Cardıac Surgery Aim: The primary aim of this study is to investigate the effect of targeted fluid therapy applied in the perioperative period on acute kidney injury in the early period in the management of patients undergoing open heart surgery with cardiopulmonary bypass. Its secondary purpose is; To investigate the factors (type of surgery, heart pump power: ejection fraction, cardiac output, CPB duration, cross-clamp time, duration of mechanical ventilation, acidosis, pump balance) in patients with acute kidney injury. Material and Methods: Sixty patients over 18 years of age, who were to undergo elective coronary artery bypass graft surgery or valve surgery, whose consent documents were obtained after approval from the local ethics committee of our hospital, were included in the study. The cases were divided into two groups: Group Control (Group K, n =): Control Group: The group in which patient fluid management was performed by traditional method. Group Esophageal Doppler (Group OD, n =): The group in which fluid management is performed according to the target. Standard monitoring method for open heart surgery was applied to all cases in the operating room. For this purpose; Invasive arterial pressure, central venous pressure, heart rate (ECG), SpO2, cerebral oximetry (NIRS), temperature, hourly urine output were monitored. In addition, the esophageal Doppler probe was placed in the group to be treated with targeted fluid therapy after the patients were anesthetized. Anesthesia induction was similar in all cases. Data collection: Hemodynamic data of the cases were recorded intraoperatively and postoperatively. Preoperative baseline value for AKI biochemical markers (urea, creat, GFR, KIM-1, Cystatin C) in blood, samples were taken at the 4th hour, 24th and 48th hours postoperatively. 51 Results: In the groups, accompanying diseases, medications used, type of operation, inotrope vasoconstrictor and vasodilator usage amounts were similar. AKI developed in 9 cases (33%) each in both groups. Distribution of KDIGO classification in AKI cases was similar. Cystatin-C was significantly higher in the Control Group at the postoperative 24th and 48th hours (Tukey HSD test, p <0.04, p <0.02). Serum KIM-1 values were similar in groups. Age in Group D and intraoperative urine output in Group K were independent risk factors in the development of AKI (Odds Ratio = 0.60, p = 0.02; Odds Ratio = 1.1; p = 0.02 respectively). In all cases, Euroskor was found to be independent risk factors for the development of AKI (Odds Ratio = 0.61, p = 0.04). Conclusion: In our study, no difference was found between the perioperative targeted therapy and the traditional method in the incidence of AKI development after open heart surgery. However, Cystatin C was significantly lower in the group in whom HYT was applied, at the 24th and 48th hours postoperatively. Hospital stay was shorter in the study group. Euroskor was found to be an independent risk factor for the development of AKI in all cases. We are of the opinion that our study increased the number of cases and included cases at risk for the development of AKI and should be supported by further studies.