Study Says Fluid Management is “Single factor to Inform about AKI”

It’s broadly accepted that the risk of Acute Kidney Injury (AKI) risk in general surgery is about 8%. Accurate intraoperative fluid monitoring provides clinicians with an important tool that helps them to avoid this often devastating complication. A newly published study in Anesthesiology News, from Columbia University Irving Medical Center, New York City adds a fresh perspective by isolating the impact of intraoperative hemodynamic variables from the known preoperative risk factors.

Minjae Kim, MD, an assistant professor of anesthesiology at the New York City institution said; “Since the kidneys are organs that rely on adequate blood flow, hemodynamic management in the operating room is critically important, particularly with respect to possible development of postoperative AKI in general surgery patients. Nevertheless, it is still unclear whether intraoperative management information can help improve our understanding of AKI risk beyond what is known preoperatively.”

Overlaying intraoperative fluid management onto risk factors known from preoperative data the study found that only the addition of fluid management variables significantly increased the “Area Under the Curve” (AUC) of the baseline model and made a significantly positive net reclassification improvement.

“So at least in this model, fluid management variables were the single factor we can say added more information about AKI risk compared to the baseline model,” Dr. Kim explained.

Commenting on the study, Frederic T. Billings IV, MD, MSc associate professor of anesthesiology and medicine at Vanderbilt University School of Medicine, Nashville, Tenn, suggested that clinicians’ reliance on preoperative factors to predict postoperative AKI may come from a historically limited ability to “collect repeatedly measured hemodynamic data in anesthesia information systems that allow for the type of analysis performed in this study.”

Deltex Medical claims technology leadership in intraoperative hemodynamic monitoring with its Esophageal Doppler system (EDM+). The core of its TrueVue platform, EDM is the only system to derive real-time fluid data direct from the aorta, 180 times a second.

As Deltex CEO Andy Mears states; “This study isolates intraoperative hemodymanic management as the only significant contributor to AKI reduction. The clear clinical need is for accuracy, which EDM is uniquely capable of delivering.”

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