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

Year 2018, Volume: 21 Issue: 3, 217 - 224, 02.12.2018

Tanıl Özer , Hakan Ceyran

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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