Table 2. Perioperative renal protection, strategies to be considered in cardiovascular surgery.

Melius abundare quam deficere*	Standard patients	Patients at high risk of acute kidney injury
Perioperative hemodynamic optimization	Optimize DO 2 through Ht, CO, HR, and paO 2 No specific device or technique is recommended	Optimize DO 2 through Ht, CO, HR, and paO 2 with any available device, technique, or protocol
Inotropes and vasoconstrictors	Optimize perfusion pressure	Optimize perfusion pressure Choose a “patient-tailored MAP” (according to the basal MAP)
Fluid management	Avoid routine fluid overload	Target therapy with a GDT protocol
Liberal transfusion therapy	Consider liberal (Hb 9) instead of a restrictive (Hb 7) transfusion strategy	Use liberal (Hb 9) instead of a restrictive (Hb 7) transfusion strategy
Renal replacement therapy	Use it in the early phase of acute kidney injury	Consider it even as a preventive strategy
Volatile	Consider routinely using them in your anesthesia plan of cardiovascular patients	Use them in CABG surgery
Remote ischemic preconditioning	Consider routinely using it in cardiovascular patients if you can avoid propofol during the procedure	Use it if you can avoid propofol
Intra-aortic balloon pump	No	Use it in high-risk CABG patients or in cardiovascular procedures with complicated course
Epidural	Weigh risks and benefits according to your expertise and patients’ preferences	Weigh risks and benefits according to your expertise and patients’ preferences
Levosimendan	No	Use it Avoid bolus Consider vasoconstrictors
Statin	Consider routinely reintroducing them immediately after surgery	Consider starting them before surgery

*Too much is better than not enough. CABG, coronary artery bypass grafting; CO, cardiac output; DO ₂, oxygen delivery; GDT, goal-directed therapy; Hb, hemoglobin; HR, heart rate; Ht, hematocrit; MAP, mean arterial pressure; paO ₂, partial pressure of oxygen in arterial blood.