The ability of tidal volume challenge test to predict early post-operative acute kidney injury and intra-operative hypotension in laparoscopic abdominal surgeries

Abstract

ABSTRACT Background Improper management and late detection of complications, especially peri-operative acute kidney injury (AKI), could result in higher morbidity and mortality rates. This work was aimed at confirming the tidal volume challenge (TVC) test’s predictability while performing laparoscopic abdominal surgery for early postoperative AKI and intra-operative hypotension. Methods Our prospective observational study involved 70 cases whose age ranged between 18 and 65 years, American Society of Anesthesiologists (ASA) I and ASA II going through general anesthesia (GA) for laparoscopic abdominal elective surgery. Patients went through a categorization into AKI or Non-AKI according to the worst Kidney Disease: Improving Global Outcomes (KDIGO) classification according to serum creatinine and urine output that are measured at 0, 24 and 48h. Results TVC exhibited significant correlation with the AKI development with the OR of 2.3, 95% CI, p = 0.052, while the exposure index was deemed to be an AKI development risk factor with the OR of 1.0, 95% CI, p = 0.034. However, baseline neutrophil gelatinase-associated lipocalin in urine (UNGAL) showed insignificant association with the AKI development with the OR 1.04 and p = 0.366. The relationship between TVC and hypotension frequency was estimated using linear regression. The regression showed that there exists a positive significant relation between these two parameters; as hypotension frequency increases, TVC increases as well with a coefficient estimate of 0.5. Conclusions AKI represents complication after laparoscopic abdominal surgery. To avoid peri-operative renal impairment, the limiting exposure index should be considered. Our work introduces the TVC test for AKI prediction in laparoscopic abdominal surgeries.