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Background: As patients with acute kidney injury (AKI) progress to a higher stage, the risk for poor outcomes dramatically rises. Early identification of patients at high risk for AKI progression remains a major challenge. This study aimed to evaluate the value of furosemide responsiveness (FR) for predicting AKI progression in patients with initial mild and moderate AKI after cardiac surgery., Methods: We performed 2 separate exploratory analyses. The Zhongshan cohort was a single-center, prospective, observational cohort, whereas the Beth Israel Deaconess Medical Center cohort was a single-center, retrospective cohort. We calculated 2 FR parameters for each patient, namely the FR index and modified FR index, defined as 2-hour urine output divided by furosemide dose (FR index, mL/mg/2 h) and by furosemide dose and body weight (modified FR index, mL/[mg·kg]/2 h), respectively. The primary outcome was AKI progression within 7 days., Results: AKI progression occurred in 80 (16.0%) and 359 (11.3%) patients in the Zhongshan and Beth Israel Deaconess Medical Center cohorts, respectively. All FR parameters (considered continuously or in quartiles) were inversely associated with risk of AKI progression in both cohorts (all adjusted P < .01). The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models involving C-index, net reclassification improvement, and integrated discrimination improvement index in both cohorts (all P < .01)., Conclusions: FR parameters were inversely associated with risk of AKI progression in patients with mild and moderate AKI after cardiac surgery. The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: To assess the relationship between the intrapulmonary shunt and PaO 2 /FiO 2 in severe hypoxemic patients after acute type A aortic dissection (ATAAD) surgery and to evaluate the effect of inhaled nitric oxide (iNO) on intrapulmonary shunt., Methods: Postoperative ATAAD patients with PaO 2 /FiO 2  ≤ 150 mmHg were enrolled. Intrapulmonary shunt was calculated from oxygen content of different sites (artery [CaO 2 ], mixed venous [CvO 2 ], and alveolar capillary [CcO 2 ]) using the Fick equation, where intrapulmonary shunt = (CcO 2 -CaO 2 )/(CcO 2 -CvO 2 ). Related variables were measured at baseline (positive end expiratory pressure [PEEP] 5 cm H 2 O), 30 min after increasing PEEP (PEEP 10 cm H 2 O), 30 min after 5 ppm iNO therapy (PEEP 10 cm H 2 O + iNO), and 30 min after decreasing PEEP (PEEP 5 cm H 2 O + iNO)., Results: A total of 20 patients were enrolled between April 2019 and December 2019. Intrapulmonary shunt and PaO 2 /FiO 2 were correlated in severe hypoxemic, postoperative ATAAD patients (adjusted R 2  = 0.467, p < 0.001). A mixed model for repeated measures revealed that iNO, rather than increasing PEEP, significantly decreased the intrapulmonary shunt (by 15% at a PEEP of 5 cm H 2 O and 16% at a PEEP of 10 cm H 2 O, p < 0.001 each) and increased PaO 2 /FiO 2 (by 63% at a PEEP of 5 cm H 2 O and 65% at a PEEP of 10 cm H 2 O, p < 0.001 each). After iNO therapy, the decrement of intrapulmonary shunt and the increment of PaO 2 /FiO 2 were also correlated (adjusted R 2  = 0.375, p < 0.001)., Conclusions: This study showed that intrapulmonary shunt and PaO 2 /FiO 2 were correlated in severe hypoxemic, postoperative ATAAD patients. Furthermore, iNO, rather than increasing PEEP, significantly decreased the intrapulmonary shunt to improve severe hypoxemic conditions., (Copyright © 2021 Elsevier Inc. All rights reserved.)