S<sub>35</sub>and derived parameters during extracorporeal circulation together with hemodilution and hypothermia in humans

Trouwborst, A.; Woerkens, E. C. S. M. Van; Rating, W.; Prakash, Om; Bos, Egbert; Wyers-hille, M. J.

doi:10.3109/00365519009087503

Cited by 6 publications

(11 citation statements)

References 4 publications

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“…Moreover, since a previous study showed that decreased SvO 2 to Ͻ50% resulted in marked increase in cognitive impairment, 13 our strategy has been to maintain SvO 2 more than 65% to sustain appropriate oxygen delivery mainly to the brain as well as to other end organs. Although blood transfusion-free open-heart surgery can be technically achieved by recent development of miniaturization of CPB circuit or refinement of perfusion strategy, we have to consider that what is safest and minimally invasive for the patients undergoing open-heart surgery because Trouwborst et al 14,15 suggested that the mixed venous oxygen saturation may remain unchanged even if the real arterial available oxygen content decreases in the setting of hemodilution. In addition, the lowest safe hematocrit can be different between acyanotic and cyanotic patients, who have completely different preoperative hematocrit and subsequent hemodilution rate.…”

Section: Discussionmentioning

confidence: 99%

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

et al. 2009

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This retrospective study analyzed the current practice of blood transfusion-free open-heart surgery in 536 children weighing 5-20 kg undergoing surgery between 2004 and 2007. A miniaturized cardiopulmonary bypass (CPB) circuit was used (priming volume; 300 ml for the flow rate <1,500 ml/min; 550 ml for the flow rate of 1500-2300 ml/min). Modified ultrafiltration was routinely performed. Criteria for blood transfusion during CPB included a hematocrit of <20% and/or mixed venous oxygen saturation of <65%. Transfusion during CPB was avoided in 264 (49.3%) of the 536 patients (5-10 kg group, 29.0%; 11-15 kg group, 67.4%; 16-20 kg group, 80.8%). There was no neurological complication related to hemodilution. Multiple logistic regression analysis revealed that body weight, preoperative hematocrit, priming volume of CPB circuit, CPB time, and lowest hematocrit during CPB predict requirement of blood transfusion (p < 0.01). Transfusion rate was lowest in the atrial septal defect group (5.6%) and highest in tetralogy of Fallot group (78.7%), being associated with complexity of diagnosis and procedure required. Blood transfusion-free open-heart surgery may be achieved in the half of the patients weighing 5-20 kg, and further miniaturization of CPB circuit and refinement of perfusion strategy might reduce transfusion rate in patients <10 kg and/or with complex congenital heart disease.

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Section: Discussionmentioning

confidence: 99%

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

et al. 2009

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“…The real arterial available oxygen content (CavlO 2 ) is defined as the total arterial oxygen content minus the oxygen content at a PO 2 of 35 mm Hg (oxygen bound to hemoglobin at a tension of less than 35 mm Hg should be considered relatively unavailable). 7,8 Therefore, the real arterial available oxygen content may vary for the same PO 2 , cardiac output, and hemoglobin values, because of changes in parameters affecting the ODC position. Trouwborst et al found that the position of the ODC also influences the amount of oxygen extracted in the capillaries from hemoglobin in pigs.…”

Section: Discussionmentioning

confidence: 99%

“…7,19 The relation between VO 2 and CavlO 2 expressed by the O 2 ERavl might give a realistic index of oxygen supply in relation to oxygen consumption. 7,8,19 The significance of oxygen transport and the role of oxygen consumption as a predictor of outcome in a variety of diseases have been stressed, [20][21][22] but ideal values for oxygen transport are difficult to maintain during liver transplantation. 2 In patients with chronic liver failure, peripheral vasodilation, mainly in the splanchnic circulation, and a compensatory increase in cardiac output and hence oxygen delivery exist.…”

Section: Discussionmentioning

confidence: 99%

“…CavlO 2 was calculated according to a described formula. [7][8][9] Cardiac index was calculated by dividing the cardiac output by the body surface area. In patients with ascites, we used the corrected weight, i.e., the measured weight before the operation minus the measured weight of ascites.…”

Section: Methodsmentioning

confidence: 99%

“…CavlO 2 was defined as the total arterial oxygen content minus the oxygen content at a PO 2 of 35 mm Hg (oxygen bound to hemoglobin at a tension of less than 35 mm Hg should be considered relatively unavailable). [7][8][9] …”

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Oxygen availability during orthotopic liver transplantation

Kostopanagiotou

Smyrniotis

Theodoraki

et al. 2003

Liver Transplantation

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Studies have stressed the role of adequate tissue oxygenation in the light of an optimal patient outcome and allograft viability in liver transplantation. The practice of monitoring conventional hemodynamic parameters during liver transplantation could be complemented by parameters assessing real oxygen availability. In the present prospective study, real arterial available oxygen content (CavlO 2 ) and its extraction ratio (O 2 ERavl) were calculated. These parameters include the effect of changes in oxyhemoglobin dissociation curve (ODC; expressed by P 50 ) on oxygen availability, under the different circumstances occurring during liver transplantation. Sixteen adult cirrhotic patients were studied during orthotopic liver transplantation with the use of venovenous bypass. Classic hemodynamic measurements using a Swan-Ganz thermodilution catheter and arterial and mixed venous blood gas analysis were performed, and P 50 , oxygen deliv-

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Changes in oxyhemoglobin dissociation curve in intrabdominal organs during pig experimental orthotopic liver transplantation

et al. 2005

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Liver transplantation has become a gold standard treatment for irreversible liver disease. Conventional measures of oxygenation are inadequate to understand the dynamics of regional oxygen metabolism during liver transplantation because they represent global markers of tissue dysoxia. Therefore, the addition of an assessment of the hemoglobin O 2 binding capacity can give a better insight into systemic and regional tissue oxygenation and can reflect a more accurate estimation of oxygen release to the tissues than can the hemoglobin, the PaO 2 and SaO 2 alone. This prospective study was designed to evaluate possible alterations in the oxyhemoglobin dissociation curve of vital end organs (small bowel, liver, and kidney) in an experimental liver transplantation model. Fifteen pigs with body weights ranging from 25 to 30 kg were used for the study. Five healthy pigs underwent a sham operation under general anesthesia (group A-control). Ten pigs underwent orthotopic liver transplantation (OLT). Five of them were healthy (group B), whereas the other five were in acute liver failure, which had been surgically induced (group C). Systemic arterial blood pressure, cardiac index, and pulmonary and systemic vascular resistance indexes were measured. Venous blood gas analysis was also performed from pulmonary artery, superior mesenteric, hepatic, and renal veins at well-defined timepoints during the course of the OLT. A statistically significant (P < 0.05) decrease of P 50 in groups B and C compared with group A was observed 30 minutes after reperfusion in the systemic circulation, hepatic, and renal veins. This coincided with a decrease in animal temperature 30 minutes after reperfusion. Regarding group C, after reperfusion of the newly transplanted liver there was a significant increase of P 50 in the small bowel in comparison to baseline values. In conclusion, these changes in P 50 may suggest the occurrence of abnormal tissue oxygenation after reperfusion. (Liver Transpl 2005;11:760-766.)

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S₃₅and derived parameters during extracorporeal circulation together with hemodilution and hypothermia in humans

Cited by 6 publications

References 4 publications

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

Oxygen availability during orthotopic liver transplantation

Changes in oxyhemoglobin dissociation curve in intrabdominal organs during pig experimental orthotopic liver transplantation

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S35and derived parameters during extracorporeal circulation together with hemodilution and hypothermia in humans

Cited by 6 publications

References 4 publications

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

Oxygen availability during orthotopic liver transplantation

Changes in oxyhemoglobin dissociation curve in intrabdominal organs during pig experimental orthotopic liver transplantation

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S₃₅and derived parameters during extracorporeal circulation together with hemodilution and hypothermia in humans