Tissue oxygenation index is a useful monitor of histologic and neurologic outcome after cardiopulmonary bypass in piglets

Hagino, Ikuo; Anttila, Vesa; Zurakowski, David; Duebener, Lennart F.; Lidov, Hart G.W.; Jonas, Richard A.

doi:10.1016/j.jtcvs.2005.02.058

Cited by 65 publications

(44 citation statements)

References 36 publications

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“…These findings are consistent with that found in preterm infants administered 3 doses of 3,000 IU/kg EPO where median cTOI was not different between EPO and placebo groups [12] . Studies have shown cTOI <50% for prolonged periods correlate with poorer neurodevelopmental outcome in preterm babies [42] and piglets [43,44] . While cTOI indicates the amount of oxygen present, cFTOE estimates the amount of oxygen extracted by brain tissue from the vascular compartment and can provide information on whether metabolic processes are increased, likely due to injury [45] .…”

Section: Discussionmentioning

confidence: 99%

Optimizing the Dose of Erythropoietin Required to Prevent Acute Ventilation-Induced Cerebral White Matter Injury in Preterm Lambs

et al. 2017

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Erythropoietin (EPO) is being trialed in preterm neonates for neuroprotection. We have recently demonstrated that a single high bolus dose (5,000 IU/kg) of recombinant human EPO amplified preterm lung and brain ventilation-induced injury. We aimed to determine the optimal dose of EPO to reduce ventilation-induced cerebral white matter inflammation and injury in preterm lambs. Lambs (0.85 gestation) were ventilated with an injurious strategy for 15 min followed by conventional ventilation for 105 min. Lambs were randomized to no treatment (VENT; n = 8) or received a bolus dose of EPO (EPREX®): 300 IU/kg (EPO 300; n = 5), 1,000 IU/kg (EPO 1,000; n = 5), or 3,000 IU/kg (EPO 3,000; n = 5). Physiological parameters were measured throughout the study. After 2 h, brains were collected for analysis; real-time quantitative polymerase chain reaction and immunohistochemistry were used to assess inflammation, cell death, and vascular leakage in the periventricular and subcortical white matter (PVWM; SCWM). Molecular and histological inflammatory indices in the PVWM were not different between groups. EPO 300 lambs had higher IL-6 (p = 0.006) and caspase-3 (p = 0.025) mRNA expression in the SCWM than VENT lambs. Blood-brain barrier (BBB) occludin mRNA levels were higher in EPO 3,000 lambs in the PVWM and SCWM than VENT lambs. The number of blood vessels with protein extravasation in the SCWM was lower in EPO 1,000 (p = 0.010) and EPO 3,000 (p = 0.025) lambs compared to VENT controls but not different between groups in the PVWM. Early administration of EPO at lower doses neither reduced nor exacerbated cerebral white matter inflammation or injury. 3,000 IU/kg EPO may provide neuroprotection by improving BBB integrity.

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Section: Discussionmentioning

confidence: 99%

Optimizing the Dose of Erythropoietin Required to Prevent Acute Ventilation-Induced Cerebral White Matter Injury in Preterm Lambs

et al. 2017

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“…Hagino et al mentioned that an rSO2 value of less than 55% is a strong predictor of neurological injury during CPB (9). Although there was no clinical cerebral complication in these cyanotic patients, we still thought it should be noted that the low rSO2 level was dangerous in pediatric patients.…”

Section: Thoughts and Progress E56mentioning

confidence: 71%

Effects of Pulsatile and Nonpulsatile Perfusion on Cerebral Regional Oxygen Saturation and Endothelin‐1 in Tetralogy of Fallot Infants

Zhao¹,

Yang²,

Liu³

et al. 2011

Artificial Organs

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Although benefits of pulsatile flow during cardiopulmonary bypass (CPB) in pediatric heart surgery remain controversial and nonpulsatile CPB is still widely used in clinical cardiac surgery, pulsatile CPB must be reconsidered due to its physiologic features. In this study, we aimed to evaluate the effects of pulsatile perfusion (PP) and nonpulsatile perfusion (NP) on cerebral regional oxygen saturation (rSO₂) and endothelin-1 (ET-1) in pediatric tetralogy of Fallot (TOF) patients undergoing open heart surgery with CPB. Forty pediatric patients were randomly divided into the PP group (n = 20) and the NP group (n = 20). Pulsatile patients used a modified roller pump during the cross-clamp period in CPB, while NP patients used a roller pump with continuous flat flow perfusion. The subjects were monitored for rSO₂ from the beginning of the operation until 6 h after returning to the intensive care unit (ICU). We also monitored the hemodynamic status and ET-1 concentration and plasma free hemoglobin (PFH) in blood samples of all patients over time. Effective PP was monitored in PP patients, and pulse pressure was significantly higher in the PP group than in the NP group (P < 0.01). rSO₂ of the PP group was higher than that of the NP group (P < 0.01) during the cross-clamp period, and this advantage of PP would be maintained until 2 h after patients returned to the ICU (P < 0.05). ET-1 level in blood samples was lower at clamping off and CPB weaning and early ICU period in the PP group than in the NP group (P < 0.01), and ET-1 concentration remained at a normal level after patients were transferred to the ICU 24 h in all patients. PFH levels in the PP group at pre-clamp off and CPB weaned off were higher than those of the NP group (P < 0.05) in these cyanotic patients. PP can increase rSO₂ and improve microcirculation during cross-clamping period in TOF pediatric patients, while PP resulted in more severe hemolysis in these cyanotic patients than NP.

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“…It is well known that prolonged ischaemic injury leads to cell necrosis caused by adenosine triphosphate (ATP) depletion, and that the injury is characterised histologically by the presence of pyknotic nuclei, swollen eosinophilic cytoplasm and the presence of an inflammatory reaction secondary to injury [10]. In an effort to protect the brain from such ischaemic injury, many investigators have reported their clinical and experimental experiences, attempting to define optimal CPB conditions before and after HCA with respect to such variables as degree of haemodilution, temperature and flow rate [19,20].…”

Section: Discussionmentioning

confidence: 99%

Hypothermic extracorporeal circulation in immature swine: a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest☆

Sasaki

Guleserian

Rose

et al. 2009

European Journal of Cardio-Thoracic Surgery

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In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.

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Tissue oxygenation index is a useful monitor of histologic and neurologic outcome after cardiopulmonary bypass in piglets

Abstract: Tissue oxygenation index is a useful monitor for defining the minimum safe flow rate during cardiopulmonary bypass. An index value of less than 55% is a strong predictor of neurologic injury.

Cited by 65 publications

References 36 publications

Optimizing the Dose of Erythropoietin Required to Prevent Acute Ventilation-Induced Cerebral White Matter Injury in Preterm Lambs

Optimizing the Dose of Erythropoietin Required to Prevent Acute Ventilation-Induced Cerebral White Matter Injury in Preterm Lambs

Effects of Pulsatile and Nonpulsatile Perfusion on Cerebral Regional Oxygen Saturation and Endothelin‐1 in Tetralogy of Fallot Infants

Hypothermic extracorporeal circulation in immature swine: a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest☆

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