Manzur-Sandoval Daniel, Gopar-Nieto Rodrigo, Torres-Pulido Abraham, Pérez-Manjarrez Aldo Alfredo, Hurtado-Belizario Karla Sue América, Riveros-Nina Daniel Gaspar, Quirazco-Córdova Ricardo Eduardo, Utrilla-Álvarez José Daniel, Elizalde-Silva José Luis, Rojas-Velasco Gustavo, Ospina-Tascón Gustavo Adolfo
Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Ann Thorac Surg Short Rep. 2023 Sep 29;2(1):131-135. doi: 10.1016/j.atssr.2023.09.009. eCollection 2024 Mar.
In the postoperative period of cardiac surgical procedure, there is an imbalance in the ratio of oxygen supply to oxygen consumption that leads to organic dysfunction and death. There is evidence of microcirculation involvement in cardiac surgical procedure, and a dysregulated inflammatory response similar to sepsis can occur.
We present a cohort of 280 consecutive adults who were monitored in the postoperative period after cardiac surgical procedure. We performed serial measurements of macrocirculatory indices, indices of global oxygenation, CO-derived indices, and perfusion indices in the first 24 hours postoperatively.
We identified a dissociation between circulatory macrohemodynamic parameters/global oxygenation indices and the CO-derived indices. The CO-derived indices constitute a surrogate for microcirculatory flow and indicate the presence of anaerobic metabolism.
A better understanding of these clinical variables will help establish optimal management protocols. It will also aid in the identification of patients in subpopulations with organic dysfunction despite conventional circulatory parameters within normal limits who can be overlooked if this exhaustive hemodynamic evaluation is not performed.
在心脏外科手术的术后阶段，氧供与氧耗的比例失衡，会导致器官功能障碍和死亡。有证据表明心脏外科手术涉及微循环，并且可能会出现类似于脓毒症的炎症反应失调。
我们呈现了一组连续280例接受心脏外科手术后进行术后监测的成年人。我们在术后头24小时内对体循环指标、整体氧合指标、心输出量衍生指标和灌注指标进行了连续测量。
我们发现体循环宏观血流动力学参数/整体氧合指标与心输出量衍生指标之间存在分离。心输出量衍生指标可作为微循环血流的替代指标，并提示无氧代谢的存在。
更好地理解这些临床变量将有助于制定最佳管理方案。这也将有助于识别尽管传统循环参数在正常范围内，但仍存在器官功能障碍的亚组患者，如果不进行这种详尽的血流动力学评估，这些患者可能会被忽视。
