Oxygenation within the first 120 h following coronary artery bypass grafting. Influence of systemic hypothermia (32 °C) or normothermia (36 °C) during the cardiopulmonary bypass: a randomized clinical trial

Rasmussen, Brian Schou; Sollid, J.; Rees, Stephen Edward; Kjærgaard, Søren; Murley, David; Toft, Egon

doi:10.1111/j.1399-6576.2006.00897.x

Cited by 22 publications

(12 citation statements)

References 31 publications

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“…Other causes of postoperative hypoxaemia are atelectasis in the immediate postoperative period7 and fluid accumulation in the lung8. Studies of the gas exchange parameters on the third postoperative day after CABG show a decrease in shunt fraction, an increase in ventilation-perfusion mismatch due to less atelectasis, and an increase in fluid accumulation and lung injury910.…”

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confidence: 99%

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Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

Maltesen

Rasmussen

Pedersen

et al. 2017

Sci Rep

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Cardiovascular disease is the leading cause of death worldwide and patients with severe symptoms undergo cardiac surgery. Even after uncomplicated surgeries, some patients experience postoperative complications such as lung injury. We hypothesized that the procedure elicits metabolic activity that can be related to the disease progression, which is commonly observed two-three days postoperatively. More than 700 blood samples were collected from 50 patients at nine time points pre-, intra-, and postoperatively. Dramatic metabolite shifts were observed during and immediately after the intervention. Prolonged surgical stress was linked to an augmented anaerobic environment. Time series analysis showed shifts in purine-, nicotinic acid-, tyrosine-, hyaluronic acid-, ketone-, fatty acid, and lipid metabolism. A characteristic ‘metabolic biosignature’ was identified correlating with the risk of developing postoperative complications two days before the first clinical signs of lung injury. Hence, this study demonstrates the link between intra- and postoperative time-dependent metabolite changes and later postoperative outcome. In addition, the results indicate that metabotyping patients’ journeys early, during or just after the end of surgery, may have potential impact in hospitals for the early diagnosis of postoperative lung injury, and for the monitoring of therapeutics targeting disease progression.

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mentioning

confidence: 99%

“…Early measurements of the partial pressure of arterial oxygen (PaO 2 ) -used to assess the degree of acute lung injury1314 - have shown poor predictive value for later outcomes15. Because the nadir values of PaO 2 appear on the second to third postoperative day910, it is difficult to predict which patients will develop lung injury at an early stage16.…”

mentioning

confidence: 99%

Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

Maltesen

Rasmussen

Pedersen

et al. 2017

Sci Rep

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“…The result of the ALPE procedure was a median DPO 2 of 1.9 kPa (1.1-3.1) and a median shunt of 12 (9-17); these data have previously been published [9,13].…”

Section: Changes In Oxygenationmentioning

confidence: 91%

“…These measurements are not routinely available in an ICU setting as right heart catherisation only is carried out in a minority of patients such as those undergoing cardiac surgery. Data on this procedure have, however, previously been recorded in two studies applying ALPE to measure pulmonary gas exchange in patients following cardiac surgery [8,9]. The hemodynamic data from these studies have neither been previously processed, nor published.…”

Section: Introductionmentioning

confidence: 97%

The effects of oxygen induced pulmonary vasoconstriction on bedside measurement of pulmonary gas exchange

Weinreich

Thomsen

Rees

et al. 2015

J Clin Monit Comput

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In patients with respiratory failure measurements of pulmonary gas exchange are of importance. The bedside automatic lung parameter estimator (ALPE) of pulmonary gas exchange is based on changes in inspired oxygen (FiO2) assuming that these changes do not affect pulmonary circulation. This assumption is investigated in this study. Forty-two out of 65 patients undergoing coronary artery bypass grafting (CABG) had measurements of mean pulmonary arterial pressure (MPAP), cardiac output and pulmonary capillary wedge pressure thus enabling the calculation of pulmonary vascular resistance (PVR) at each FiO2 level. The research version of ALPE was used and FiO2 was step-wise reduced a median of 0.20 and ultimately returned towards baseline values, allowing 6-8 min' steady state period at each of 4-6 levels before recording the oxygen saturation (SpO2). FiO2 reduction led to median decrease in SpO2 from 99 to 92 %, an increase in MPAP of 4 mmHg and an increase in PVR of 36 dyn s cm(-5). Changes were immediately reversed on returning FiO2 towards baseline. In this study changes in MPAP and PVR are small and immediately reversible consistent with small changes in pulmonary gas exchange. This indicates that mild deoxygenation induced pulmonary vasoconstriction does not have significant influences on the ALPE parameters in patients after CABG.

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“…So gibt es keine Unterschiede in zentral-und lebervenöser Sättigung während der Reperfusion und keine Unterschiede der Inflammationsreaktion [19]. Die postoperative Lungenfunktion zeigt ebenfalls keine Unterschiede und ist gleichermaßen eingeschränkt [24]. Auch zwischen einem hypothermem Herzstillstand mit konventioneller EKZ gegenüber einer Minimal-EKZ mit OP am schlagenden Herzen finden sich keine Unterschiede in postoperativer Herzfunktion und proinflammatorischer Reaktion [25].…”

Section: Introductionunclassified

Hypothermia in cardiac surgery

Schirmer

2007

Anaesthesist

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Since the beginning of the era of cardiac surgery hypothermia remains a mainstay in perioperative management. This role is increasingly being questioned because of many disadvantages and the lack of evidence of advantages. Using modern techniques of perfusion and myocardial protection as well as improved surgical techniques the results with normothermia seem to be comparable. The importance of hypothermia in present day cardiac surgery is discussed with respect to myocardial and cerebral protection.

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Oxygenation within the first 120 h following coronary artery bypass grafting. Influence of systemic hypothermia (32 °C) or normothermia (36 °C) during the cardiopulmonary bypass: a randomized clinical trial

Abstract: Impaired oxygenation is prevalent and prolonged following CABG, with equal intensity after hypothermic and normothermic CPB.

Cited by 22 publications

References 31 publications

Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

The effects of oxygen induced pulmonary vasoconstriction on bedside measurement of pulmonary gas exchange

Hypothermia in cardiac surgery

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