Cerebral Oxymeter Changes and Clinical Outcomes at Different Hypothermic Levels During Cardiopulmonary Bypass in Pediatric Patients

Abstract

Introduction: Cardiopulmonary bypass (CPB) may not provide sufficient tissue perfusion. Hypothermia is used to protect the organs, especially the brain and heart, from this perfusion insufficiency. We investigated the effect of different hypothermic levels on cerebral oxygenation during CPB by using a cerebral oxymeter.

Patients and Methods: The study included 30 consecutive pediatric patients with congenital heart disease who were planned to be operated on in the year 2012. The mean age was 41.83 ± 39.96 months (2-156 months), with 19 males. Children were divided into three groups by different hypothermic levels at CPB (32°C, 30°C, and 28°C). The measurements were made five times: before anesthesia induction (baseline values), during cooling (34°C), at the coldest value (first group 32°C, second group 30°C, third group 28°C), during rewarming (34°C), and at the end of rewarming (37°C-38°C). Cerebral-oxygen saturation, arterial-oxygen saturation, arterial carbon dioxide pressure, mean arterial pressure, pH, lactate, base excess, and hematocrit measurements were made for all patients, and mean values were calculated for each group.

Results: There were no significant differences between the 32°C, 30°C, and 28°C groups (p> 0.05). When comparing change in cerebral-oxygen saturation values with the other parameters’ changes between the periods, mean arterial pressure, and hematocrit changes showed noteworthy similarities. However, no relationship had been found between the other parameters and cerebral-oxygen saturation.

Conclusion: In our study, it was observed that cerebral oxygenation had not changed significantly at different hypothermic degrees of moderate levels during CPB. The highest temperature level of moderate hypothermic degrees (32°C instead of 28°C) was secure enough. This might be more advantageous to avoid the possible negative effects of hypothermia. Close monitoring of the cerebral oxygenation with cerebral oximetry may play an important role in ensuring patients’ safety.

Keywords

• Cardiopulmonary bypass,cerebral oxymeter,near-infrared spectroscopy,hypothermia,cerebral perfusion

Pediatrik Hastalarda Kardiyopulmoner Baypas Sırasında Farklı Hipotermik Seviyelerinde Serebral Oksimetri Değişimi ve Klinik Sonuçları

Abstract

Giriş: Kardiyopulmoner baypas (KPB) yeterli doku perfüzyonu sağlayamayabilir. Organları bu perfüzyon yetersizliğinden korumak için hipotermi kullanılır. Biz çalışmamızda farklı hipotermik seviyelerin serebral oksijenasyona etkisini serebral oksimetre kullanarak araştırmayı amaçladık.

Hastalar ve Yöntem: Çalışmaya konjenital kalp cerrahisi uygulanan 30 pediatrik hasta dahil edildi. Ortalama yaş 41.83 ± 39.96 ay (2-156 ay), 19 erkek. Hastalar KPB’deki farklı hipotermik seviyelere göre üç gruba ayrıldı. Ölçümler beş farklı aşamada yapıldı: anestezi indüksiyonu öncesi, soğuma aşamasında (34°C), en son soğuma değerinde (1. Grup 32°C, 2. Grup 30°C, 3. Grup 28°C), ısınma aşamasında (34°C), ısınmanın sonunda (37-38°C). Her hasta için serebral oksijen satürasyonu, arteriyel oksijen satürasyonu, arteriyel karbondioksit basıncı, ortalama arter basıncı, pH, laktat, baz fazlası, hematokrit ölçümleri yapıldı ve ortalama değerler her grup için hesaplandı.

Bulgular: Kaydedilen değerlerin karşılaştırıldığında 32°C, 30°C ve 28°C gruplarında anlamlı fark yoktu (p> 0.05). Serebral oksijen satürasyonundaki değişim ile diğer parametrelerdeki değişimler ile ortalama arter basıncı ve hematokrit değerlerindeki değişimler kayda değer benzerlik göstermekteydi. Bununla beraber, serebral oksijen satürasyonu ile diğer parametreler arasında ilişki bulunamadı.

Sonuç: Serebral oksijenasyonun farklı hipotermik seviyelerde değişmediği göz önüne alındığında, sıcaklık seviyesini mümkün olduğunca korumanın hipoterminin olası negatif etkilerinden korumada önemli olduğunu düşünmekteyiz. Ayrıca serebral oksijenasyonun serebral oksimetre ile yakın monitörizasyonu hastanın güvenliğini sağlamada önemli rol oynayabilir.

Keywords

• Kardiyopulmoner baypas,serebral oksimetri,kızıl ötesi spektroskopi,hipotermi,serebral perfüzyon

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