Srey Rithy, Rance Geoffrey, Shapeton Alexander D, Leissner Kay B, Zenati Marco A
Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts.
Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; and.
J Extra Corpor Technol. 2019 Sep;51(3):172-174.
Traditionally, blood flow rates on cardiopulmonary bypass are based primarily on a formula that matches cardiac index to the patient's body surface area (BSA). However, Ranucci and associates in the Goal-Directed Perfusion Trial (GIFT) trial have shown that coupling the BSA with delivery of oxygen (DO), known as goal-directed perfusion (GDP), may be a safer approach to determine appropriate blood flows. The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO of 280 mL·minm. A quick reference GDP chart was created based on the derived formula, requiring only the patient's BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery center to adopt the GDP technique, even in the absence of instantaneous DO monitoring equipment.
传统上，体外循环时的血流速率主要基于一个将心脏指数与患者体表面积（BSA）相匹配的公式。然而，拉努奇及其同事在目标导向灌注试验（GIFT）中表明，将体表面积与氧输送量（DO）相结合，即所谓的目标导向灌注（GDP），可能是确定合适血流的更安全方法。本研究的目的是创建一个GDP参考工具，使灌注师能够快速确定为任何体表面积的患者提供满意的氧输送量所需的最低可接受血流，而无需额外的专用技术。我们通过推导一个基于体表面积、血液氧含量和最低280 mL·min⁻¹的氧输送量的血流公式（L/min）来解决这个问题。根据推导公式创建了一个快速参考GDP图表，只需患者的体表面积和血红蛋白水平就能确定安全的最低流速。所提出的工具使任何心脏手术中心都能采用GDP技术，即使在没有即时氧输送量监测设备的情况下。
