Nousjka P A Vranken1, Yuri M Ganushchak2, Henriëtte M Willigers3, Jos G Maessen2, Patrick W Weerwind2. 1. Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute, Maastricht, The Netherlands. Electronic address: nousjka.vranken@mumc.nl. 2. Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute, Maastricht, The Netherlands. 3. Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Abstract
OBJECTIVE: To evaluate parameters of the vascular occlusion test (VOT) before, during, and after pulsatile cardiopulmonary bypass (CPB). DESIGN: Prospective, observational study. SETTING: Single-center university hospital. PARTICIPANTS: Adult patients undergoing elective cardiac surgery with pulsatile CPB. INTERVENTIONS: An oximeter sensor and adult-sized pneumatic tourniquet were positioned at the right forearm. A VOT with a predefined ischemic time of 3 minutes was performed before, during, and after CPB. Changes in tissue oxygen saturation were recorded. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients who underwent cardiac surgery were enrolled in the study. The lowest tissue oxygen saturation measured during the ischemic challenge differed among all 3 stages of surgery, with median values of 62.9% before, 57.5% during, and 59.3% after perfusion (p<0.05). Both occlusion (p<0.001) and reperfusion (p<0.05) slopes were steeper after bypass compared with before initiating bypass, whereas the reperfusion time remained constant among the different time points. CONCLUSIONS: The microcirculatory function as demonstrated by changes in VOT parameters was enhanced during and after normothermic pulsatile CPB. Clinical relevance, however, needs to be further explored.
OBJECTIVE: To evaluate parameters of the vascular occlusion test (VOT) before, during, and after pulsatile cardiopulmonary bypass (CPB). DESIGN: Prospective, observational study. SETTING: Single-center university hospital. PARTICIPANTS: Adult patients undergoing elective cardiac surgery with pulsatile CPB. INTERVENTIONS: An oximeter sensor and adult-sized pneumatic tourniquet were positioned at the right forearm. A VOT with a predefined ischemic time of 3 minutes was performed before, during, and after CPB. Changes in tissue oxygen saturation were recorded. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients who underwent cardiac surgery were enrolled in the study. The lowest tissue oxygen saturation measured during the ischemic challenge differed among all 3 stages of surgery, with median values of 62.9% before, 57.5% during, and 59.3% after perfusion (p<0.05). Both occlusion (p<0.001) and reperfusion (p<0.05) slopes were steeper after bypass compared with before initiating bypass, whereas the reperfusion time remained constant among the different time points. CONCLUSIONS: The microcirculatory function as demonstrated by changes in VOT parameters was enhanced during and after normothermic pulsatile CPB. Clinical relevance, however, needs to be further explored.
Authors: Zühre Uz; Can Ince; Philippe Guerci; Yasin Ince; Renata P Araujo; Bulent Ergin; Matthias P Hilty; Thomas M van Gulik; Bas A de Mol Journal: Perioper Med (Lond) Date: 2018-08-09