A comparative clinical study on the effects of cardiopulmonary bypass with different flows and pressures on skeletal muscle cell metabolism in patients undergoing coronary bypass grafting

Canale, S. Del; Vezzani, Antonella; Belli, Laura; Coffrini, E.; Guariglia, A; Ronda, Nicoletta; Vitali, P; Beghi, Cesare; Fesani, F; Borghetti, A; Fiaccadori, Enrico

doi:10.1016/s0022-5223(19)37019-9

Cited by 11 publications

(3 citation statements)

References 19 publications

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“…• an increase of SVRI; 4,5 • a blood flow shift among various organs and within each organ (the well-demonstrated corticomedullary perfusion shift in the renal parenchyma); 6 • metabolic acidosis; 7 • interstitial fluids expansion; 8 • opening of artero-venous shunts 9 and capillary collapse; 5 • a decline of lymphatic flow; 10 • a lower encephalic oxygenation; 11 • an unfavourable neuroendocrine response. 12 The present study assesses plasma catecholamine level variations in CABG patients subjected to normothermic CPB, in relation to two different perfusion modes: the theoretically more physiologic pulsatile perfusion and the totally nonphysiological nonpulsatile perfusion.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels

et al. 2000

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The aim of the study was to assess plasma catecholamine levels in patients undergoing myocardial revascularization and relate them to pulsatile (P) and nonpulsatile (NP) normothermic cardiopulmonary bypass (CPB). Twenty-eight patients were randomly assigned to different CPB management: 15 patients were assigned to group 'P', 13 patients to group 'NP'. During normothermic extracorporeal circulation, group 'P' received pulsatile perfusion, while group 'NP' received nonpulsatile perfusion. Levels of epinephrine and norepinephrine were evaluated during the operation and in the intensive care unit (ICU), at seven time points. Haemodynamic assessment was performed at four time points in the same period. Demographic and surgical data were collected, and the postoperative course was analysed. Epinephrine levels were markedly increased during CPB in both groups, while norepinephrine increased more in group NP in comparison with group P. No significant difference was found in fluid administration, transfusion, drugs usage, or postoperative complications. Normothermic pulsatile CPB seems to achieve reduced levels of norepinephrine. A clinical beneficial effect of this finding was not demonstrated during the study.

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Section: Discussionmentioning

confidence: 99%

Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels

et al. 2000

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“…This latter study, in which skeletal muscle biopsies were obtained after hypothermic bypass, found a persisting oxygen deficit in the tissues, exhaustion of the cell's functional reserve and an activation of anaerobic metabolism. 52 A canine model of CPB has found that mucosal acidosis coincides with increased gut VO 2 at a time when DO 2 was relatively fixed. 53 This decline in the pHi coincided with reduced pO 2 in the mesenteric vein.…”

Section: Mucosal Oxygenationmentioning

confidence: 99%

Gastrointestinal Dysfunction Following Cardiac Surgery

Ohri

Velissaris

2006

Perfusion

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Cardiac surgery is associated with a low incidence of GI complications, but with a disproportionate mortality. A number of risk factors have become established which identify patients at risk. CPB is associated with profound reductions in mucosal blood flow. Mesenteric perfusion is altered by primary endothelial dysfunction, which may further be exacerbated by the use of vasoconstrictors during CPB; inflammatory mediators can 'prime' the mesenteric vasculature. Cardiac surgery with or without CPB is associated with increased tissue oxygen demands, particularly by the splanchnic bed. The disparity in general and regional oxygen supply and demand results in the development of mucosal hypoxia and this cannot be attributed to CPB alone. This injury is measurable by reductions in both absorptive and barrier functions of the gut. Protection may be conferred by modulating the perfusion protocol during bypass and pharmacological interventions which modify the inflammatory response to surgery.

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“…On the other hand, the use of both higher flow rates and mean arterial pressures could theoretically provide higher oxygen delivery (DO 2 ) rates, as well as possible haemodynamic advantages in selected patients with either impaired renal function or carotid arterial disease (Del Canale et al 1990). Thus maintenance of the normothermic perfusion flow rate during moderate hypothermic haemodilutional CPB may provide a safety margin that may compensate for the unexpected increase of whole body oxygen consumption (VO 2 ) or decrease of DO 2 (Baraka 1993).…”

Section: Introductionmentioning

confidence: 99%

Response of some biophysical properties of blood to changes in the perfusion flow rate during cardiopulmonary bypass

Ali

2001

Physiol. Meas.

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Cardiopulmonary bypass (CPB) is a safe support system during major cardiac operations because it allows the distribution of adequately oxygenated blood to the entire body. The optimal perfusion flow to be used during hypothermic CPB remains a controversial issue. In the present study, the effect of different flows and pressures on oxygen delivery, extraction and consumption was compared. Such an effect was evaluated for 40 patients undergoing open-heart surgery using CPB (membrane oxygenator) and systemic hypothermia. The patients were randomized into two groups (20 each) according to the flow and pressure (low flow, low pressure and high flow, high pressure). The electrical impedance from 50 Hz to 10 MHz for blood samples and erythrocytes for both groups was also measured at different time intervals (before-, during and post-CPB). No significant change for low flow group was recorded (p > 0.05) while the dielectric properties of the high-flow group were greatly affected by the time of operation. Hence, low flow can be safely used in young patients without any organ impairment or carotid artery disease, while high flow should be used for patients with any organ dysfunction, at the initiation of CPB and during rewarming to compensate for the increase in oxygen consumption and the need for better perfusion pressure.

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A comparative clinical study on the effects of cardiopulmonary bypass with different flows and pressures on skeletal muscle cell metabolism in patients undergoing coronary bypass grafting

Cited by 11 publications

References 19 publications

Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels

Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels

Gastrointestinal Dysfunction Following Cardiac Surgery

Response of some biophysical properties of blood to changes in the perfusion flow rate during cardiopulmonary bypass

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