Cardiovascular and Thoracic AnesthesiologySPECIAL ARTICLEThe Society of Thoracic Surgeons/Society ofCardiovascular Anesthesiologists/American Societyfor Extracorporeal Technology Clinical PracticeGuidelines for the Prevention of Adult CardiacSurgery-Associated Acute Kidney InjuryJeremiah R.Brown,PhD,MS,*Robert A.Baker,PhD,CCP+Linda Shore-Lesserson,MD,Amanda A.Fox,MD,MPH,S Linda B.Mongero,CCPlI Kevin W.Lobdell,MD,T Scott A.LeMaire,MD,#Filip M.J.J.De Somer,PhD,EBCP**Moritz Wyler von Ballmoos,MD,PhD,tViachaslau Barodka,MD,Rakesh C.Arora,MD,PhD,SS Scott Firestone,MS,lllRichard Solomon,MD,TT Chirag R.Parikh,MD,PhD,#Kenneth G.Shann,CCP***andJohn Hammon,MD+tABBREVIATIONS AND ACRONYMSACEi angiotensin-converting enzyme inhibitors ARBs angiotensin-receptor blockersCABG coronary artery bypass graft CPB=cardiopulmonary bypass CSA-AKI cardiac sur-gery-associated acute kidney injury Do2 delivered oxygen Do2i =delivered oxygen indexKDIGO=Kidney Disease Improving Global Outcomes ICU intensive care unit MiECC =minimallyinvasive extracorporeal circulation OR odds ratio RCT=randomized controlled trial RIFLE=Risk,Injury,Failure,Loss,End-StageEXECUTIVE SUMMARYrecommended to reduce the risk of CSA-AKI (Class of Recommendation:I,Level of1.In adult cardiac surgery with cardiopulmonarybypass (CPB),avoiding hyperthermic perfu-Evidence:B-R)sion (>37 C)is recommended to reduce the3.In adult cardiac surgery with CPB,it is reason-risk of cardiac surgery-associated acute kidneyable to adopt the Kidney Disease Improvinginjury(CSA-AKI).(Class of Recommendation:Global Outcomes (KDIGO)practice guidelinesI,Level of Evidence:B-R)for patients at high risk of AKI to reduce the2.In adult cardiac surgery with CPB,arisk of CSA-AKI(Class of Recommendationgoal-directed oxygen delivery strategy isIIA;Level of Evidence B-R)Departments of Epidemiology,Biomedical Data Science,and HealthUniversity School of Medicine,Baltimore,Maryland;++Division ofPolicy and Clinical Practice,Dartmouth Geisel School of Medicine,Cardiac Surgery,Massachusetts General Hospital,Boston,Massachusetts;Hanover,New Hampshire;+Cardiothoracic Surgery Quality andand tttDepartment of Cardiothoracic Surgery,Wake Forest UniversityOutcomes Unit and Perfusion Service,Department of Surgery,FlindersSchool of Medicine,Winston-Salem,North CarolinaMedical Centre and Flinders University,Adelaide,South AustraliaAustralia;Department of Anesthesiology,Zucker School of MedicineAccepted for publication Jun 25,2022.at Hofstra/Northwell,Hempstead,New York;SDepartment ofConflicts of Interest:See Disclosures at the end of the article.Anesthesiology and Pain Management,University of Texas SouthwesternMedical Center,Dallas,Texas;McDermott Center for Human Growth andSupplemental digital content is available for this article.Direct URLcitationsDevelopment,University of Texas Southwestern Medical Center,Dallas,appear in the printed text and are provided in the HTML and PDF versionsTexas;llSpecialtyCare,Inc,Brentwood,Tennessee:Cardiovascularof this
