ArticleJournal of cardiothoracic and vascular anesthesia2025
Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass.
Article in Journal of cardiothoracic and vascular anesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Intraoperative blood pressure management in noncardiac surgery: a narrative review based on current evidence.Intensive care medicine · 2026Review
- Venous congestion from a vascular waterfall perspective: reframing congestion as a dynamic Starling resistor phenomenon.Intensive care medicine experimental · 2025Review
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Authors and funding
8 authors.
Funding
Abstract
objectivesOptimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI).
designRetrospective cohort study.
settingSingle tertiary care hospital
participantsWe included 1,038 adult cardiac surgery patients who underwent CPB.
interventionsPcrit was calculated using arterial waveform data before initiation of CPB. Pcrit was examined in relation to incidence of stage 2 or higher postoperative AKI according to standard Kidney Disease Improving Global Outcomes definitions. MEASUREMENTS AND MAIN
resultsOf the 1,038 patients included in the study, 50 (5%) experienced AKI. Patients who suffered AKI had significantly higher preoperative risk factors, including higher incidence of severe chronic kidney disease and higher Society of Thoracic Surgeons risk score (p < 0.01). They also had longer operative times and longer cross-clamp times (p < 0.01). All patients were maintained at similar mean arterial pressure while on CPB. Patients who suffered AKI had a significantly higher prebypass Pcrit than those who did not (49.0 mmHg vs 44.1 mmHg; p = 0.018). In a multivariate regression, Pcrit remained a significant predictor, representing a 16% increased risk of AKI for each 5 mmHg increase in prebypass Pcrit (p = 0.011).
conclusionsA higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.
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