OBJECTIVES: In cardiac surgery, the choice of temperature regimen during cardiopulmonary bypass (CPB) remains a subject of debate. Hypothermia reduces tissue metabolic demands, but may impair the autoregulation of cerebral blood flow and contribute to neurological morbidity. The aim of this study was to evaluate the effect of two different temperature regimens during CPB on the systemic oxygen transport and the cerebral oxygenation during surgical correction of acquired heart diseases. METHODS: In a prospective study, we randomized 40 adult patients with combined valvular disorders requiring surgical correction of two or more valves into two groups: (i) a normothermic (NMTH) group (n = 20), in which the body core temperature was maintained at 36.6°C during CPB and (ii) a hypothermic (HPTH) group (n = 20), in which the body was cooled to a core temperature of 32°C maintained throughout the period of CPB. The systemic oxygen transport and the cerebral oxygen saturation (SctO2) were assessed by means of a PiCCO2 haemodynamic monitor and a cerebral oximeter, respectively. All the patients received standard perioperative monitoring. We assessed haemodynamic and oxygen transport parameters, the duration of mechanical ventilation and the length of the ICU and the hospital stays. RESULTS: During CPB, central venous oxygen saturation was significantly higher in the HPTH group but SctO2 was increased in the NMTH group (P < 0.05). Cardiac index, systemic oxygen delivery and consumption increased postoperatively in both groups. However, oxygen delivery and consumption were significantly higher in the NMTH group (P < 0.05). The duration of respiratory support and the length of ICU and hospital stays did not differ between the groups. CONCLUSIONS: During combined valve surgery, normothermic CPB provides lower central venous oxygen saturation, but increases cerebral tissue oxygenation when compared with the hypothermic regimen.
RCT Entities:
OBJECTIVES: In cardiac surgery, the choice of temperature regimen during cardiopulmonary bypass (CPB) remains a subject of debate. Hypothermia reduces tissue metabolic demands, but may impair the autoregulation of cerebral blood flow and contribute to neurological morbidity. The aim of this study was to evaluate the effect of two different temperature regimens during CPB on the systemic oxygen transport and the cerebral oxygenation during surgical correction of acquired heart diseases. METHODS: In a prospective study, we randomized 40 adult patients with combined valvular disorders requiring surgical correction of two or more valves into two groups: (i) a normothermic (NMTH) group (n = 20), in which the body core temperature was maintained at 36.6°C during CPB and (ii) a hypothermic (HPTH) group (n = 20), in which the body was cooled to a core temperature of 32°C maintained throughout the period of CPB. The systemic oxygen transport and the cerebral oxygen saturation (SctO2) were assessed by means of a PiCCO2 haemodynamic monitor and a cerebral oximeter, respectively. All the patients received standard perioperative monitoring. We assessed haemodynamic and oxygen transport parameters, the duration of mechanical ventilation and the length of the ICU and the hospital stays. RESULTS: During CPB, central venous oxygen saturation was significantly higher in the HPTH group but SctO2 was increased in the NMTH group (P < 0.05). Cardiac index, systemic oxygen delivery and consumption increased postoperatively in both groups. However, oxygen delivery and consumption were significantly higher in the NMTH group (P < 0.05). The duration of respiratory support and the length of ICU and hospital stays did not differ between the groups. CONCLUSIONS: During combined valve surgery, normothermic CPB provides lower central venous oxygen saturation, but increases cerebral tissue oxygenation when compared with the hypothermic regimen.
Authors: Mark F Newman; Joseph P Mathew; Hilary P Grocott; G Burkhard Mackensen; Terri Monk; Kathleen A Welsh-Bohmer; James A Blumenthal; Daniel T Laskowitz; Daniel B Mark Journal: Lancet Date: 2006-08-19 Impact factor: 79.321
Authors: Sarah Baos; Karen Sheehan; Lucy Culliford; Katie Pike; Lucy Ellis; Andrew J Parry; Serban Stoica; Mohamed T Ghorbel; Massimo Caputo; Chris A Rogers Journal: JMIR Res Protoc Date: 2015-05-25
Authors: Marcin Maruszewski; Radosław Smoczyński; Mariusz Kowalewski; Maciej Bartczak; Anna Witkowska; Jakub Staromłyński; Dominik Drobiński; Mariusz Kujawski; Piotr Suwalski Journal: Wideochir Inne Tech Maloinwazyjne Date: 2019-01-22 Impact factor: 1.195
Authors: Lars J Bjertnæs; Torvind O Næsheim; Eirik Reierth; Evgeny V Suborov; Mikhail Y Kirov; Konstantin M Lebedinskii; Torkjel Tveita Journal: Front Med (Lausanne) Date: 2022-02-23