Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis

Tovedal, Thomas; Thelin, Stefan; Lennmyr, Fredrik

doi:10.1177/0267659115586280

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…Clinically, brain NIRS has been used as a marker for cerebral oxygenation during the intraoperative management of cardiopulmonary bypass and carotid endarterectomy (8,10,11,18). It has also been investigated for use in the management of adult and neonatal ischemic brain injury (1,3,6,14) and traumatic brain injury (22).…”

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confidence: 99%

The correlation between brain near-infrared spectroscopy and cerebral blood flow in piglets with intracranial hypertension

2016

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Cerebral perfusion pressure (CPP) is used as a surrogate for measurement of cerebral blood flow (CBF) but its determination requires that intracranial pressure be directly measured. Near-infrared spectroscopy (NIRS) can noninvasively measure tissue oxygenation. We hypothesized that NIRS would correlate well with CBF, with cerebral metabolism of oxygen (CMRO2) and glucose and with lactate production as CPP was reduced. Seven anesthetized piglets were subjected to reductions in CPP to 60, 50, 40, 30, and 20 mmHg by infusing an artificial cerebral spinal fluid into the lateral ventricle of the brain. After a period of equilibration, NIRS over the left temporal cortex and regional CBF (microspheres) were measured at each CPP level as well as arterial and internal jugular PaO2 , glucose, and lactate. CMRO2 and glucose consumption and lactate production were calculated by standard formulae. NIRS correlated very well (P < 0.05) with CBF in the left temporal cortex [mean r (95% CI) = 0.95 (0.91-0.99)] and with left hemispheric CMRO2 [0.94 (0.90-0.98)], glucose consumption [0.87 (0.76-0.97)], and lactate production [0.89 (0.81-0.97)]. The correlation of NIRS with CBF was slightly better (P < 0.05) than that of CPP with CBF [0.89 (0.84-0.94)]. In this model of global cerebral hypertension, NIRS correlated well with CBF and measures of cerebral metabolism, and might be useful as a surrogate for CPP. Further studies are warranted to determine if NIRS is associated with these variables in focal cerebral injury.

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confidence: 99%

The correlation between brain near-infrared spectroscopy and cerebral blood flow in piglets with intracranial hypertension

2016

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“…The role of carotid stenosis as a significant variable in cerebral blood supply is not clear yet, although some researchers attempted to discuss this subject. Tovedal et al 23 evaluated flow type during CPB in two groups of patients, each group comprised of 10 subjects. Despite the fact that they detected no significant changes in cerebral oxygenation between groups, the tissue oxygenation index tended to be decreased in patients with carotid stenosis in the pulsatile manner of CPB.…”

Section: Discussionmentioning

confidence: 99%

The effect of pulsatile versus non-pulsatile flow during cardiopulmonary bypass on cerebral oxygenation: A randomized trial

Moosaeifar

Mousavizadeh

Ghezeljeh

et al. 2021

Asian Cardiovasc Thorac Ann

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Background The present study aims to compare regional oxygen supply determined by Near-Infrared Spectroscopy in the course of pulsatile perfusion with non-pulsatile perfusion during cardiopulmonary bypass in patients undergoing valvular heart surgery. Methods In this prospective randomized single-blinded trial, we enrolled adult subjects aged 18–65 years scheduled for elective valvular heart repair/replacement surgery with non-stenotic carotid arteries, employing a consecutive sampling method. Eligible patients were then randomly assigned in a 1:1 ratio to pulsatile or non-pulsatile perfusion during aortic cross-clamp. The primary outcome was regional cerebral oxygenation monitored by Near-Infrared Spectroscopy in each group. Results Seventy patients were randomly assigned, and each group comprised 35 patients. Mean age was 46.8 and 46.5 years in pulsatile and non-pulsatile groups, respectively. There were no significant between-group differences in regional cerebral oxygen saturation at different time points of cardiopulmonary bypass ( p-value for analysis of variance repeated measures: 0.923 and 0.223 for left and right hemispheres, respectively). Moreover, no significant differences in regional cerebral oxygen saturation levels from baseline between pulsatile and non-pulsatile groups at all desired time points for the left ( p = 0.51) and right ( p = 0.22) hemispheres of the brain were detected. Conclusion Pulsatile perfusion during cardiopulmonary bypass does not offer superior regional cerebral oxygenation measured by Near-Infrared Spectroscopy than non-pulsatile perfusion during cardiopulmonary bypass. Nonetheless, the efficacy of pulsatile flow in the subgroup of patients in whom cerebral blood flow is impaired due to carotid artery stenosis needs to be explored and evaluated by this method in future studies.

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“…They found that a high MAP would be highly recommended for the protection of the brain and the abdominal organs especially for patients with high risk of embolization. [19] That would actually be and the most obvious practice during CPB. An increase in the MAP and the maintenance of a higher blood pressure would reimburse the drop of the pressure across the stenosis [20].…”

Section: Blood Pressure During Cpb: Role and Particularitiesmentioning

confidence: 99%

“…Tovedal and colleagues found that there is no difference in cerebral oxygenation between these two techniques but MAP was decreased during pulsatile flow. [19] Similar questions might be formed about the importance of blood flow and pressure when using a roller pump, where the output remains constant, or a centrifugal pump where the output fluctuates depending on the peripheral resistance of the vessels. Finally, how would the superiority or the inferiority of pressure towards flow would be proved in cases where the former is mainly generated by the latter and not by vasoconstrictors or vasodilators?…”

Section: Blood Pressure During Cpb: Role and Particularitiesmentioning

confidence: 99%

Advanced Perfusion Techniques - Flow versus Pressure

Pappa¹,

Theodosiadis²,

Paliouras³

et al. 2017

J. Biomed

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Cardiac operations which require Cardiopulmonary bypass (CPB) are considered the most common procedures in cardiac surgery, performed for more than half a century, especially in Europe and North America. Despite that new technologies are being incorporated in CPB as long as the development of new techniques in CPB, some debates still remain. These debates regard the achievement of the needed optimal perfusion during CPB and the relation between perfusion pressures and the optimal blood flow during extracorporeal circulation. Blood flow and blood pressure during Cardiopulmonary bypass are very important factors. Although more studies are in favor of a minor superiority of the optimal blood flow requirements, compared to the corresponding optimal blood pressure needs, their role is quite interdependent. The usage of contemporary electronic Data Management Systems (DMS) led to a significant evolution of the perfusion science. Adequate perfusion can now be judged by its results in real time, while information from DMS, such as venous saturation, levels of haemoglobin and lactate, may be used as the markers of optimal perfusion and additionally for the development of the perfusion protocols in the future.

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Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis

Cited by 8 publications

References 32 publications

The correlation between brain near-infrared spectroscopy and cerebral blood flow in piglets with intracranial hypertension

The correlation between brain near-infrared spectroscopy and cerebral blood flow in piglets with intracranial hypertension

The effect of pulsatile versus non-pulsatile flow during cardiopulmonary bypass on cerebral oxygenation: A randomized trial

Advanced Perfusion Techniques - Flow versus Pressure

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