Analysis of the Factors Related to a Decrease in Jugular Venous Oxygen Saturation in Patients with Diabetes Mellitus During Normothermic Cardiopulmonary Bypass

Abstract

Cerebrovascular CO(2) reactivity in diabetic patients decreased after the cessation of CPB but not in the control patients. In addition, HbA1c is also thought to be a factor related to a decrease in SjvO(2) in diabetic patients.

Diabetes Mellitus Does Not Affect Jugular Bulb Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

“…The sample size calculation was based on the previous similar study 12 that the SjvO2 value in diabetic patients would be decreased by 10% compared with that in control patients with standard deviation of 10% during coronary artery grafting. For an alpha error of 0.05 and power of 90%, a total of 23 patients per group were found to be necessary.…”

“…The pathway that appears most affected by DM is that of nitric oxide 20 and CPB might alter the cerebral endothelial function more extensively in diabetic patients than in non-diabetic patients. 12 As a result, diabetic patients lose the normal coupling of cerebral blood flow with metabolism during CPB and usual cerebral blood flow-perfusion pressure relationship. 7 CVR-CO2 has significant correlation with cerebral autoregulatory index and diabetic patients with reduced CVR-CO2 were reported to have a tendency to have a cerebral desaturation state.…”

“…21 As a result of such impairment of cerebrovascular function, in a series of studies observing cerebral oxygenation with SjvO2, diabetic patients more often experienced cerebral desaturation (<SjvO2 50%) than non-diabetic patients during CPB. 7,12 Cerebral desaturation during CPB is also reported to be closely related to postoperative neurological disorder. 22 Considering that impaired cerebrovascular function in diabetic patients are mostly related to CPB and use of CPB is the only predictor of short-term cognitive dysfunction after CABG, 23 OPCAB could exert beneficial effect in terms of cerebral oxygenation in patients with DM.…”

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

“…192 The pathophysiology of CPB-associated brain injury is multifactorial 2 but is thought to involve regional hypoperfusion and tissue hypoxia, 193,194 often within vascular beds that are already abnormal because of advanced age or comorbidities such as diabetes. 195,196 Adequate cerebral tissue oxygen delivery during CPB is achieved by optimisation of several parameters including CPB pump flows, perfusion pressure, haematocrit and the oxygen saturation of arterial blood. Currently, the adequacy of perfusion is determined by the use of global measures of oxygen utilisation, such as mixed venous oxygen saturation (SvO 2 ), or evidence of tissue hypoxia, as implied by indicators of metabolic acidosis or elevated serum lactate, a marker of cell anaerobic metabolism.…”

Neuropsychological dynamics in patients with type 2 diabetes mellitus undergone coronary artery bypass grafting

“…По-видимому, это объясняется более выраженными процессами дис-регуляции в коре головного мозга у пациентов с СД2, чем у пациентов без нарушения углеводного обмена. Полученные в нашей работе данные подтверждаются результатами исследований, где показано, что частота когнитивной дисфункции в раннем послеоперационном периоде КШ у пациентов с СД выше, чем у пациентов без диабета [21,22].…”