A Norepinephrine Weaning Strategy Using Dynamic Arterial Elastance is Associated with Reduction of Acute Kidney Injury in Patients with Vasoplegia after Cardiac Surgery: A Post-Hoc Analysis of the Randomized SNEAD Study.

STUDY OBJECTIVE:To evaluate the impact of a dynamic arterial elastance guided norepinephrine weaning strategy on the occurrence of acute kidney injury (AKI) in patients with vasoplegia after cardiac surgery.DESIGN:A post-hoc analysis of a monocentric randomized controlled trial.SETTING:A tertiary care hospital in France.PARTICIPANTS:Vasoplegic cardiac surgical patients treated with norepinephrine.INTERVENTION:Patients were randomized to an algorithm-based norepinephrine weaning intervention (dynamic arterial elastance) group or a control group.MEASUREMENTS:The primary endpoint was the number of patients with AKI defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The secondary endpoint were major adverse cardiac post-operative events (new onset of atrial fibrillation or flutter, low cardiac output syndrome, and in-hospital death). End points were evaluated during the first seven post-operative days.RESULTS:118 patients were analyzed. In the overall study population, the mean age was 70 (62-76) years, 65% were male and the median EuroSCORE was 7 (5-10). Overall, 46 (39%) patients developed AKI (30 KDIGO 1, 8 KDIGO 2, 8 KDIGO 3), and 6 patients required renal replacement therapy. The incidence of AKI was significantly lower in the intervention group than in the control group (16 patients (27%) vs 30 patients (51%), p = 0.12). Higher dose and longer duration of norepinephrine were associated with AKI severity.CONCLUSION:Decreasing norepinephrine exposure by using a dynamic arterial elastance guided norepinephrine weaning strategy was associated with a reduced incidence of acute kidney injury in patients with vasoplegia after cardiac surgery. Further prospective multicentric studies are needed to confirm these results.