Eisner Christoph, Adam Heimo, Weigand Markus A, Zivkovic Aleksandar R
Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany.
Department of Cardiovascular Perfusion, Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany.
J Pers Med. 2024 Jun 27;14(7):691. doi: 10.3390/jpm14070691.
(1) Background: Adequate organ perfusion during cardiopulmonary bypass (CPB) requires accurate estimation and adjustment of flow rates which conventional methods may not always achieve. Perioperative monitoring of cerebral oxygen saturation (ScO) may detect changes in oxygen transport. This study aims to compare estimated and measured perfusion flow rates and assess the capacity of ScO to detect subtle changes in oxygen transport during CPB. (2) Methods: This observational study included 50 patients scheduled for elective coronary artery bypass grafting (CABG) surgery, all of whom provided written informed consent. Perfusion flow rates were estimated using the DuBois formula and measured using echocardiography and a flow probe in the arterial line of the CPB system. ScO was continuously monitored, alongside intermittent measurements of oxygen delivery and extraction ratios. (3) Results: Significant discrepancies were found between estimated flow rates (5.2 [4.8-5.5] L/min) and those measured at the start of the surgery (4.6 [4.0-5.0] L/min). These discrepancies were flow rate-dependent, being more pronounced at lower perfusion rates and diminishing as rates increased. Furthermore, ScO showed a consistent correlation with both oxygen delivery (r = 0.48) and oxygen extraction ratio (r = 0.45). (4) Conclusions: This study highlights discrepancies between estimated and actual perfusion flow rates during CPB and underscores the value of ScO monitoring as a continuous, noninvasive tool for maintaining adequate organ perfusion, suggesting a need for improved, patient-tailored perfusion strategies.
(1) 背景：体外循环（CPB）期间充足的器官灌注需要准确估计和调整流速，而传统方法可能并不总能做到这一点。围手术期对脑氧饱和度（ScO）的监测可能会检测到氧输送的变化。本研究旨在比较估计的和测量的灌注流速，并评估ScO在CPB期间检测氧输送细微变化的能力。(2) 方法：这项观察性研究纳入了50例计划进行择期冠状动脉旁路移植术（CABG）的患者，所有患者均提供了书面知情同意书。灌注流速使用杜波依斯公式进行估计，并使用超声心动图和CPB系统动脉管路中的流量探头进行测量。连续监测ScO，同时间歇性测量氧输送和氧摄取率。(3) 结果：发现估计流速（5.2 [4.8 - 5.5] L/分钟）与手术开始时测量的流速（4.6 [4.0 - 5.0] L/分钟）之间存在显著差异。这些差异与流速有关，在较低灌注流速时更为明显，随着流速增加而减小。此外，ScO与氧输送（r = 0.48）和氧摄取率（r = 0.45）均呈现一致的相关性。(4) 结论：本研究突出了CPB期间估计的和实际的灌注流速之间的差异，并强调了ScO监测作为维持充足器官灌注的连续、非侵入性工具的价值，表明需要改进针对患者的灌注策略。
