Cardiac Output Augmentation During Hypoxemia Improves Cerebral Metabolism After Hypothermic Cardiopulmonary Bypass Jess M. Schultz, MD, Tara Karamlou,

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Presentation transcript:

Cardiac Output Augmentation During Hypoxemia Improves Cerebral Metabolism After Hypothermic Cardiopulmonary Bypass Jess M. Schultz, MD, Tara Karamlou, MD, Irving Shen, MD, Ross M. Ungerleider, MD The Annals of Thoracic Surgery Volume 81, Issue 2, Pages 625-633 (February 2006) DOI: 10.1016/j.athoracsur.2005.06.042 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Cerebral blood flow (CBF [in mL/100 g cerebral tissue/min]) at baseline, and at the experimental time points: hyperoxemia (PaO2 150 to 250 mm Hg), moderate hypoxemia (PaO2 50 to 60 mm Hg) , severe hypoxemia (PaO2 30 to 40 mm Hg), and severe hypoxemia-increased flow (PaO2 30 to 40 mm Hg). After exposure to hypothermia, the CBF of the intermittent hypothermic low-flow (ILF) group (triangles) was higher than the hypothermic circulatory arrest (HCA) group (diamonds) at hyperoxemia (p = 0.04), and hypoxemia (p = 0.04), and severe hypoxemia-increased flow (p = 0.02). The CBF of the hypothermic low-flow (HLF) group (squares) was greater than the HCA group only during hyperoxemia (p = 0.04) and severe hypoxemia-increased flow (p = 0.02). Within groups, increasing cardiopulmonary bypass flow during severe hypoxemia, led to increased CBF for the ILF group (p = 0.04) and the HLF group (p = 0.02). The Annals of Thoracic Surgery 2006 81, 625-633DOI: (10.1016/j.athoracsur.2005.06.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Cerebral delivery of oxygen (CDO2 [in mL O2/100 g cerebral tissue/min]) at baseline, and at the experimental time points: hyperoxemia (PaO2 150 to 250 mm Hg), moderate hypoxemia (PaO2 50 to 60 mm Hg) , severe hypoxemia (PaO2 30 to 40 mm Hg), and severe hypoxemia-increased flow (PaO2 30 to 40 mm Hg). After exposure to hypothermia, the CDO2 of the intermittent hypothermic low-flow (ILF) group (triangles) and the hypothermic low-flow (HLF) group (squares) was higher than that of the hypothermic circulatory arrest (HCA) group (diamonds) at hyperoxemia (p = 0.03 and p = 0.02, respectively), severe hypoxemia (p = 0.03 and p = 0.02, respectively), and severe hypoxemia-increased flow (p = 0.005 and p = 0.02, respectively), Within groups, CDO2 decreased from hyperoxemia to severe hypoxemia in the ILF (p = 0.04), HLF (p = 0.003), and HCA (p = 0.002) groups. Increasing cardiopulmonary bypass flow during severe hypoxemia led to increased CDO2 for the ILF (p = 0.03), CLF (p = 0.03), and HCA (p = 0.04) groups. The Annals of Thoracic Surgery 2006 81, 625-633DOI: (10.1016/j.athoracsur.2005.06.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Cerebral metabolic rate of oxygen consumption (CMRO2 [in mL O2/100 g cerebral tissue/min]) at baseline, and at the experimental time points: hyperoxemia (PaO2 150 to 250 mm Hg), moderate hypoxemia (PaO2 50 to 60 mm Hg), severe hypoxemia (PaO2 30 to 40 mm Hg), and severe hypoxemia-increased flow (PaO2 30 to 40 mm Hg). The CMRO2 of the hypothermic circulatory arrest (HCA) group (diamonds) was significantly less at hyperoxemia than at baseline (p = 0.03). The CMRO2 of the intermittent hypothermic low-flow (ILF) group (triangles) and the hypothermic low-flow (HLF) group (squares) was higher than the HCA group at hyperoxemia (p = 0.002 and p = 0.02, respectively), hypoxemia (p = 0.02 and p = 0.1, respectively), severe hypoxemia (p = 0.01 and p = 0.02, respectively), and severe hypoxemia-increased flow (p = 0.008 and p = 0.02, respectively). The Annals of Thoracic Surgery 2006 81, 625-633DOI: (10.1016/j.athoracsur.2005.06.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions