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Eisner C, Adam H, Weigand MA, Zivkovic AR. Cerebral Oxygen Saturation Associates with Changes in Oxygen Transport Parameters during Cardiopulmonary Bypass. J Pers Med 2024; 14:691. [PMID: 39063945 PMCID: PMC11277785 DOI: 10.3390/jpm14070691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Adequate organ perfusion during cardiopulmonary bypass (CPB) requires accurate estimation and adjustment of flow rates which conventional methods may not always achieve. Perioperative monitoring of cerebral oxygen saturation (ScO2) may detect changes in oxygen transport. This study aims to compare estimated and measured perfusion flow rates and assess the capacity of ScO2 to detect subtle changes in oxygen transport during CPB. (2) Methods: This observational study included 50 patients scheduled for elective coronary artery bypass grafting (CABG) surgery, all of whom provided written informed consent. Perfusion flow rates were estimated using the DuBois formula and measured using echocardiography and a flow probe in the arterial line of the CPB system. ScO2 was continuously monitored, alongside intermittent measurements of oxygen delivery and extraction ratios. (3) Results: Significant discrepancies were found between estimated flow rates (5.2 [4.8-5.5] L/min) and those measured at the start of the surgery (4.6 [4.0-5.0] L/min). These discrepancies were flow rate-dependent, being more pronounced at lower perfusion rates and diminishing as rates increased. Furthermore, ScO2 showed a consistent correlation with both oxygen delivery (r = 0.48) and oxygen extraction ratio (r = 0.45). (4) Conclusions: This study highlights discrepancies between estimated and actual perfusion flow rates during CPB and underscores the value of ScO2 monitoring as a continuous, noninvasive tool for maintaining adequate organ perfusion, suggesting a need for improved, patient-tailored perfusion strategies.
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Affiliation(s)
- Christoph Eisner
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany;
| | - Heimo Adam
- Department of Cardiovascular Perfusion, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany;
| | - Markus A. Weigand
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany;
| | - Aleksandar R. Zivkovic
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany;
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2
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Wanner PM, Vogt AP, Filipovic M, Steiner LA. Intraoperative hypotension and postoperative outcomes: just the tip of the iceberg. Comment on Br J Anaesth 2023; 131: 823-31. Br J Anaesth 2024; 132:804-805. [PMID: 38262854 DOI: 10.1016/j.bja.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Patrick M Wanner
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
| | - Andreas P Vogt
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miodrag Filipovic
- Division of Perioperative Intensive Care Medicine, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Luzius A Steiner
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
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Liu XY, Mu JJ, Han JG, Pang MJ, Zhang K, Zhai WQ, Su N, Ni GJ, Guo ZG, Ming D. Heart-brain axis: low blood pressure during off-pump CABG surgery is associated with postoperative heart failure. Mil Med Res 2024; 11:18. [PMID: 38509590 PMCID: PMC10956228 DOI: 10.1186/s40779-024-00522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Xiu-Yun Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China.
- State Key Laboratory of Advanced Medical Materials and Devices, Tianjin, 300072, China.
- Haihe Laboratory of Brain -Computer Interaction and Human-Machine Integration, Tianjin, 300380, China.
| | - Jing-Jing Mu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Jian-Ge Han
- Department of Anesthesiology, Tianjin University Chest Hospital, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin, 300222, China
| | - Mei-Jun Pang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Kuo Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Wen-Qian Zhai
- Department of Anesthesiology, Tianjin University Chest Hospital, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin, 300222, China
| | - Nan Su
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Guang-Jian Ni
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Zhi-Gang Guo
- Department of Cardiac Surgery, Tianjin University Chest Hospital, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin, 300222, China.
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China.
- State Key Laboratory of Advanced Medical Materials and Devices, Tianjin, 300072, China.
- Haihe Laboratory of Brain -Computer Interaction and Human-Machine Integration, Tianjin, 300380, China.
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Desebbe O, Bachelard E, Deperdu M, Manet R, Alexander B, Beuvelot J, Nloga J, Joosten A, Gergelé L. Quick Assessment of the Lower Limit of Cerebral Autoregulation Using Transcranial Doppler during Cardiopulmonary Bypass in Cardiac Surgery: A Feasibility Study. Rev Cardiovasc Med 2023; 24:156. [PMID: 39077528 PMCID: PMC11264067 DOI: 10.31083/j.rcm2406156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 07/31/2024] Open
Abstract
Background During cardiac surgery, maintaining a mean arterial pressure (MAP) within the range of cerebral autoregulation (CA) may prevent postoperative morbidity. The lower limit of cerebral autoregulation (LLA) can be determined using the mean velocity index (Mx). The standard Mx is averaged over a ten second period ( Mx 10s ) while using a two second averaging period ( Mx 2s ) is faster and may record more rapid variations in LLA. The objective of this study is to compare a quick determination of LLA (qLLA) using Mx 2s with the reference LLA (rLLA) using Mx 10s . Methods Single center, retrospective, observational study. Patients undergoing cardiac surgery with cardiopulmonary bypass. From January 2020 to April 2021, perioperative transcranial doppler measuring cerebral artery velocity was placed on cardiac surgery patients in order to correlate with continuous MAP values. Calculation of each patient's Mx was manually determined after the surgery and qLLA and rLLA were then calculated using a threshold value of Mx > 0.4. Results 55 patients were included. qLLA was found in 78% of the cases versus 47% for rLLA. Despite a -3 mmHg mean bias, limits of agreement were large [-19 mmHg (95% CI: -13; -25), and +13 mmHg (95% CI: +6; +19)]. There was an important interobserver variability (kappa rLLA = 0.46; 95% CI: 0.24-0.66; and Kappa qLLA = 0.36; 95% CI: 0.20-0.52). Conclusions Calculation of qLLA is feasible. However, the large limits of agreement and significant interobserver variability prevent any clinical utility or interchangeability with rLLA.
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Affiliation(s)
- Olivier Desebbe
- Department of Anesthesiology and Intensive Care, Ramsay Sante, Sauvegarde Clinic, 69009 Lyon, France
| | - Etienne Bachelard
- Department of Anesthesiology and Intensive Care, Lyon Sud University Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France
- Lyon Est Medicine Faculty, Claude Bernard Lyon 1 University, 69008 Lyon, France
| | - Marie Deperdu
- Cardiovascular, Metabolic and Nutritional Regulations, Claude Bernard University, 69008 Lyon, France
| | - Romain Manet
- Department of Neurosurgery B, P. Wertheimer Hospital, Hospices Civils de Lyon, 69002 Lyon, France
| | - Brenton Alexander
- Department of Anesthesiology, University of California, San Diego, CA 92093, USA
| | - Johanne Beuvelot
- Department of Anesthesiology and Intensive Care, Ramsay Sante, Sauvegarde Clinic, 69009 Lyon, France
| | - Joseph Nloga
- Department of Cardiac Surgery, Ramsay Health Care, Sauvegarde Clinic, 69009 Lyon, France
| | - Alexandre Joosten
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, AP-HP. Paris Saclay University, Paul Brousse Hospital, 94800 Villejuif, France
| | - Laurent Gergelé
- Department of Intensive Care, Ramsay Heath Care, Hôpital Privé de la Loire, 42100 Saint Etienne, France
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Robba C, Battaglini D, Rasulo F, Lobo FA, Matta B. The importance of monitoring cerebral oxygenation in non brain injured patients. J Clin Monit Comput 2023:10.1007/s10877-023-01002-8. [PMID: 37043157 PMCID: PMC10091334 DOI: 10.1007/s10877-023-01002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. While there are many neuromonitoring modalities utilized in brain injured patients, the majority of those are either invasive such as intracranial pressure monitoring, require special skill such as transcranial Doppler ultrasonography, or intermittent such as pupillometry and therefore unable to provide continuous monitoring. Cerebral oximetry using Near infrared Spectroscopy, is a simple non invasive continuous measure of cerebral oxygenation that has been shown to be useful in preventing cerebral hypoxemia both within the intensive care unit and the perioperative settings. At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy.
- Department of Surgical Science and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesco Rasulo
- Department of Anesthesia and Intensive Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Francisco A Lobo
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Basil Matta
- Neurocritical Care Unit, Cambridge University Hospitals, Cambridge, UK
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Ranucci M, Cotza M, Di Dedda U. The Conundrum of Systemic Arterial Pressure Management on Cardiopulmonary Bypass. J Clin Med 2023; 12:jcm12030806. [PMID: 36769463 PMCID: PMC9918189 DOI: 10.3390/jcm12030806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The recently released EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass (CPB) in adult cardiac surgery [...].
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7
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Michálek P, Říha H, Pořízka M. Year 2022 in review - Cardiac anesthesia and postoperative care. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Zipfel J, Wikidal B, Schwaneberg B, Schuhmann MU, Magunia H, Hofbeck M, Schlensak C, Schmid S, Neunhoeffer F. Identifying the optimal blood pressure for cerebral autoregulation in infants after cardiac surgery by monitoring cerebrovascular reactivity-A pilot study. Paediatr Anaesth 2022; 32:1320-1329. [PMID: 36083106 DOI: 10.1111/pan.14555] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/13/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advances in the treatment of pediatric congenital heart disease have increased survival rates. Despite efforts to prevent neurological injury, many patients suffer from impaired neurodevelopmental outcomes. Compromised cerebral autoregulation can increase the risk of brain injury following pediatric cardiac surgery with cardiopulmonary bypass. Monitoring autoregulation and maintaining adequate cerebral blood flow can help prevent neurological injury. AIMS Our objective was to evaluate autoregulation parameters and to define the optimal blood pressure as well as the lower and upper blood pressure limits of autoregulation. METHODS Autoregulation was monitored prospectively in 36 infants after cardiopulmonary bypass surgery for congenital heart defects between January and December 2019. Autoregulation indices were calculated by correlating invasive arterial blood pressure, cortical oxygen saturation, and relative tissue hemoglobin levels with near-infrared spectroscopy parameters. RESULTS The mean patient age was 4.1 ± 2.8 months, and the mean patient weight was 5.2 ± 1.8 kg. Optimal mean arterial pressure could be identified in 88.9% of patients via the hemoglobin volume index and in 91.7% of patients via the cerebral oxygenation index, and a lower limit of autoregulation could be found in 66.7% and 63.9% of patients, respectively. No significant changes in autoregulation indices at the beginning or end of the monitoring period were observed. In 76.5% ± 11.1% and 83.8% ± 9.9% of the 8 and 16 h monitoring times, respectively, the mean blood pressure was inside the range of intact autoregulation (below in 21.5% ± 25.4% and 11.3% ± 16.5% and above in 8.7% ± 10.4% and 6.0% ± 11.0%, respectively). The mean optimal blood pressure was 57.4 ± 8.7 mmHg and 58.2 ± 7.9 mmHg and the mean lower limit of autoregulation was 48.8 ± 8.3 mmHg and 45.5 ± 6.7 mmHg when generated via the hemoglobin volume index and cerebral oxygenation index, respectively. CONCLUSIONS Postoperative noninvasive autoregulation monitoring after cardiac surgery in children can be reliably and safely performed using the hemoglobin volume index and cerebral oxygenation index and provides robust data. This monitoring can be used to identify individual hemodynamic targets to optimize autoregulation, which differs from those recommended in the literature. Further evaluation of this subject is needed.
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Affiliation(s)
- Julian Zipfel
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Berit Wikidal
- Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Bernadett Schwaneberg
- Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Martin U Schuhmann
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Michael Hofbeck
- Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - Simon Schmid
- Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Felix Neunhoeffer
- Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany
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