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J Thorac Cardiovasc Surg. 2014 Jan;147(1):483-9. doi: 10.1016/j.jtcvs.2013.07.069. Epub 2013 Sep 26.

Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality.

Author information

1
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
2
Department of Pediatrics and Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
3
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
4
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Md.
5
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Md.
6
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: chogue2@jhmi.edu.

Abstract

OBJECTIVES:

Optimizing blood pressure using near-infrared spectroscopy monitoring has been suggested to ensure organ perfusion during cardiac surgery. Near-infrared spectroscopy is a reliable surrogate for cerebral blood flow in clinical cerebral autoregulation monitoring and might provide an earlier warning of malperfusion than indicators of cerebral ischemia. We hypothesized that blood pressure below the limits of cerebral autoregulation during cardiopulmonary bypass would be associated with major morbidity and operative mortality after cardiac surgery.

METHODS:

Autoregulation was monitored during cardiopulmonary bypass in 450 patients undergoing coronary artery bypass grafting and/or valve surgery. A continuous, moving Pearson's correlation coefficient was calculated between the arterial pressure and low-frequency near-infrared spectroscopy signals and displayed continuously during surgery using a laptop computer. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was compared between patients with and without major morbidity (eg, stroke, renal failure, mechanical lung ventilation >48 hours, inotrope use >24 hours, or intra-aortic balloon pump insertion) or operative mortality.

RESULTS:

Of the 450 patients, 83 experienced major morbidity or operative mortality. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was independently associated with major morbidity or operative mortality after cardiac surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.71; P = .008).

CONCLUSIONS:

Blood pressure management during cardiopulmonary bypass using physiologic endpoints such as cerebral autoregulation monitoring might provide a method of optimizing organ perfusion and improving patient outcomes from cardiac surgery.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00981474.

KEYWORDS:

CABG; CBF; COx; CPB; MAP; MMOM; NIRS; cardiopulmonary bypass; cerebral blood flow; cerebral oximetry index; coronary artery bypass grafting; major morbidity and operative mortality; mean arterial pressure; near-infrared spectroscopy; rScO(2); regional cerebral oxygen saturation

PMID:
24075467
PMCID:
PMC3865134
DOI:
10.1016/j.jtcvs.2013.07.069
[Indexed for MEDLINE]
Free PMC Article

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