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Cerebral Perfusion During Cardiopulmonary Bypass in Children: Correlations Between Near‐Infrared Spectroscopy, Temperature, Lactate, Pump Flow, and Blood Pressure
Author(s) -
Haydin Sertac,
Onan Burak,
Onan Ismihan Selen,
Ozturk Erkut,
Iyigun Muzeyyen,
Yeniterzi Mehmet,
Bakir Ihsan
Publication year - 2013
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2012.01554.x
Subject(s) - cardiopulmonary bypass , hematocrit , medicine , anesthesia , cerebral perfusion pressure , cerebral blood flow , oxygenation , cardiology , weaning , stage (stratigraphy) , perfusion , paleontology , biology
Abstract Near‐infrared spectroscopy ( NIRS ) is a noninvasive modality to monitor regional brain oxygenation (r SO 2 ). In this study, we aimed to investigate the correlation between cerebral r SO 2 and lactate, pump flow, hematocrit, p CO 2 , and mean blood pressure ( MBP ) during cardiopulmonary bypass ( CPB ). Between M arch and S eptember 2011, 50 pediatric patients who underwent congenital heart surgery were enrolled into the study. Ages ranged from 6 days to 168 months (median 14 months). A NIRS sensor (Somanetics 5100B, Troy, MI , USA ) was placed on the right forehead of patients. CPB period was divided into five stages: 1—at the beginning of CBP , 2—cooling at 32° C , 3—at final hypothermic temperature, 4—rewarming at 32° C , 5—before weaning from CPB . Data collection included measurements of each parameter at five stages of CPB . Data were analyzed using multivariate analysis within groups and Spearman's correlation to test association between parameters. Lactate levels increased significantly from stage 1 to stage 5 during CPB ( P < 0.05). There was no significant correlation between cerebral r SO 2 and MBP s, pump flows, hematocrit, or p CO 2 during CPB . Cerebral r SO 2 levels showed changes between the stages; there was a significant increase during cooling period, compared to stage 1 ( P < 0.05). Significant changes during cooling stage did not happen for other parameters. At stage 3, there was a negative correlation between lactate level and MBP . At stage 4, there was no significant change in cerebral r SO 2 levels despite decreased MBP . At the warming stage, low MBP s, but normal r SO 2 values, are observed despite increased pump flows. Increased r SO 2 levels despite insignificant changes at other parameters during the cooling stage of CPB may show that optimal pump flow with adequate intravascular volume may provide effective cerebral perfusion even without changes in MBP . Considering normal r SO 2 values during CPB in this study, it may be speculated that brain protection can be assessed by using NIRS and applying a standard bypass protocol.