Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults
Objective: The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27°C) cardiopulmonary bypass. Design, Setting, and Participants: The investigation was a prospective, randomized study...
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| Veröffentlicht in: | Journal of cardiothoracic and vascular anesthesia 1997-06, Vol.11 (4), p.415-419 |
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| container_title | Journal of cardiothoracic and vascular anesthesia |
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| creator | Cook, David J. Proper, Jacqueline A. Orszulak, Thomas A. Daly, Richard C. Oliver, William C. |
| description | Objective:
The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27°C) cardiopulmonary bypass.
Design, Setting, and Participants:
The investigation was a prospective, randomized study in a tertiary care hospital setting. The 30 participants were volunteer adult cardiac surgical patients at a single institution.
Interventions:
The N20 saturation method of Kety and Schmidt was used to determine global cerebral blood flow and metabolic rate during four periods: prebypass, cardiopulmonary bypass (CPB) (27°C) flow rates of 2.3 and 1.2 L/min/m
2, and 30 minutes post-CPB. Anesthesia consisted of fentanyl and midazolam; pH management was a-stat, and mean arterial pressure was maintained at 50 to 70 mmHg throughout CPB.
Measurements and Main Results:
In the context of an unchanged mean arterial pressure, the pump flow did not affect cerebral blood flow or metabolic rate during hypothermic CPB. Systemic venous oxygen saturation was also maintained during reduced flow at 27°C. Hemodilution during hypothermic CPB maintained cerebral blood flow at prebypass levels. In the postbypass period, persistent hemodilution resulted in an elevated cerebral blood flow.
Conclusions:
Brain oxygenation is well maintained at lower than conventional pump flow levels during CPB. There may be practical advantages to reduced flows during hypothermia, and flow reductions do not appear to adversely affect cerebral blood flow or metabolism. |
| doi_str_mv | 10.1016/S1053-0770(97)90047-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_79064017</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1053077097900471</els_id><sourcerecordid>79064017</sourcerecordid><originalsourceid>FETCH-LOGICAL-c389t-6f7a21120f1a47d75ddc3fd487a6fca26f0e8288ee5802681a54bad81c05b3763</originalsourceid><addsrcrecordid>eNqFkc1O3TAQRq2qCOhtHwHJC1S1i1DbiWNnhRACWgmJBe3amtjj4sqJg51Q3bcncG_ZdjWWvjM_OibkhLMzznj77Z4zWVdMKfalU187xhpV8XfkmMtaVLoR4v36_occkQ-l_GGMcynVITnsuFadVsfEXnmPdqbJ02kZJupj-kszzEjTSC1m7DNE2seU3C5zSw7jb_qwndL8gHkIllrILqRpiUMaIW9pv52gFBpGCm6Jc_lIDjzEgp_2dUN-XV_9vPxe3d7d_Li8uK1srbu5ar0CwblgnkOjnJLO2dq7RitovQXReoZaaI0oNROt5iCbHpzmlsm-Vm29IZ93c6ecHhcssxlCsRgjjJiWYlTH2oZxtYJyB9qcSsnozZTDsJ5uODMvcs2rXPNiznTKvMo1fO072S9Y-gHdW9fe5pqf7nMoFqLPMNpQ3jChmGjWuRtyvsNwlfEUMJtiA44WXcjrXxiXwn8OeQZilJcd</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>79064017</pqid></control><display><type>article</type><title>Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Cook, David J. ; Proper, Jacqueline A. ; Orszulak, Thomas A. ; Daly, Richard C. ; Oliver, William C.</creator><creatorcontrib>Cook, David J. ; Proper, Jacqueline A. ; Orszulak, Thomas A. ; Daly, Richard C. ; Oliver, William C.</creatorcontrib><description>Objective:
The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27°C) cardiopulmonary bypass.
Design, Setting, and Participants:
The investigation was a prospective, randomized study in a tertiary care hospital setting. The 30 participants were volunteer adult cardiac surgical patients at a single institution.
Interventions:
The N20 saturation method of Kety and Schmidt was used to determine global cerebral blood flow and metabolic rate during four periods: prebypass, cardiopulmonary bypass (CPB) (27°C) flow rates of 2.3 and 1.2 L/min/m
2, and 30 minutes post-CPB. Anesthesia consisted of fentanyl and midazolam; pH management was a-stat, and mean arterial pressure was maintained at 50 to 70 mmHg throughout CPB.
Measurements and Main Results:
In the context of an unchanged mean arterial pressure, the pump flow did not affect cerebral blood flow or metabolic rate during hypothermic CPB. Systemic venous oxygen saturation was also maintained during reduced flow at 27°C. Hemodilution during hypothermic CPB maintained cerebral blood flow at prebypass levels. In the postbypass period, persistent hemodilution resulted in an elevated cerebral blood flow.
Conclusions:
Brain oxygenation is well maintained at lower than conventional pump flow levels during CPB. There may be practical advantages to reduced flows during hypothermia, and flow reductions do not appear to adversely affect cerebral blood flow or metabolism.</description><identifier>ISSN: 1053-0770</identifier><identifier>EISSN: 1532-8422</identifier><identifier>DOI: 10.1016/S1053-0770(97)90047-1</identifier><identifier>PMID: 9187987</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Adult ; Anesthetics, Inhalation - blood ; Anesthetics, Intravenous - administration & dosage ; Biological and medical sciences ; Blood Pressure ; Brain - metabolism ; Carbon Dioxide - blood ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass - instrumentation ; cardiopulmonarybypass flow rate ; cerebral blood flow ; cerebral metabolic rate ; Cerebrovascular Circulation ; Fentanyl - administration & dosage ; Hemodilution ; Hemoglobins - analysis ; Humans ; Hydrogen-Ion Concentration ; Hypothermia, Induced ; Kety-Schmidt technique ; Medical sciences ; Midazolam - administration & dosage ; Nitrous Oxide - blood ; Oxygen - blood ; Oxygen Consumption ; Prospective Studies ; Rheology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Veins</subject><ispartof>Journal of cardiothoracic and vascular anesthesia, 1997-06, Vol.11 (4), p.415-419</ispartof><rights>1997</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-6f7a21120f1a47d75ddc3fd487a6fca26f0e8288ee5802681a54bad81c05b3763</citedby><cites>FETCH-LOGICAL-c389t-6f7a21120f1a47d75ddc3fd487a6fca26f0e8288ee5802681a54bad81c05b3763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S1053-0770(97)90047-1$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2702405$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9187987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cook, David J.</creatorcontrib><creatorcontrib>Proper, Jacqueline A.</creatorcontrib><creatorcontrib>Orszulak, Thomas A.</creatorcontrib><creatorcontrib>Daly, Richard C.</creatorcontrib><creatorcontrib>Oliver, William C.</creatorcontrib><title>Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults</title><title>Journal of cardiothoracic and vascular anesthesia</title><addtitle>J Cardiothorac Vasc Anesth</addtitle><description>Objective:
The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27°C) cardiopulmonary bypass.
Design, Setting, and Participants:
The investigation was a prospective, randomized study in a tertiary care hospital setting. The 30 participants were volunteer adult cardiac surgical patients at a single institution.
Interventions:
The N20 saturation method of Kety and Schmidt was used to determine global cerebral blood flow and metabolic rate during four periods: prebypass, cardiopulmonary bypass (CPB) (27°C) flow rates of 2.3 and 1.2 L/min/m
2, and 30 minutes post-CPB. Anesthesia consisted of fentanyl and midazolam; pH management was a-stat, and mean arterial pressure was maintained at 50 to 70 mmHg throughout CPB.
Measurements and Main Results:
In the context of an unchanged mean arterial pressure, the pump flow did not affect cerebral blood flow or metabolic rate during hypothermic CPB. Systemic venous oxygen saturation was also maintained during reduced flow at 27°C. Hemodilution during hypothermic CPB maintained cerebral blood flow at prebypass levels. In the postbypass period, persistent hemodilution resulted in an elevated cerebral blood flow.
Conclusions:
Brain oxygenation is well maintained at lower than conventional pump flow levels during CPB. There may be practical advantages to reduced flows during hypothermia, and flow reductions do not appear to adversely affect cerebral blood flow or metabolism.</description><subject>Adult</subject><subject>Anesthetics, Inhalation - blood</subject><subject>Anesthetics, Intravenous - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure</subject><subject>Brain - metabolism</subject><subject>Carbon Dioxide - blood</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiopulmonary Bypass - instrumentation</subject><subject>cardiopulmonarybypass flow rate</subject><subject>cerebral blood flow</subject><subject>cerebral metabolic rate</subject><subject>Cerebrovascular Circulation</subject><subject>Fentanyl - administration & dosage</subject><subject>Hemodilution</subject><subject>Hemoglobins - analysis</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Hypothermia, Induced</subject><subject>Kety-Schmidt technique</subject><subject>Medical sciences</subject><subject>Midazolam - administration & dosage</subject><subject>Nitrous Oxide - blood</subject><subject>Oxygen - blood</subject><subject>Oxygen Consumption</subject><subject>Prospective Studies</subject><subject>Rheology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Veins</subject><issn>1053-0770</issn><issn>1532-8422</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1O3TAQRq2qCOhtHwHJC1S1i1DbiWNnhRACWgmJBe3amtjj4sqJg51Q3bcncG_ZdjWWvjM_OibkhLMzznj77Z4zWVdMKfalU187xhpV8XfkmMtaVLoR4v36_occkQ-l_GGMcynVITnsuFadVsfEXnmPdqbJ02kZJupj-kszzEjTSC1m7DNE2seU3C5zSw7jb_qwndL8gHkIllrILqRpiUMaIW9pv52gFBpGCm6Jc_lIDjzEgp_2dUN-XV_9vPxe3d7d_Li8uK1srbu5ar0CwblgnkOjnJLO2dq7RitovQXReoZaaI0oNROt5iCbHpzmlsm-Vm29IZ93c6ecHhcssxlCsRgjjJiWYlTH2oZxtYJyB9qcSsnozZTDsJ5uODMvcs2rXPNiznTKvMo1fO072S9Y-gHdW9fe5pqf7nMoFqLPMNpQ3jChmGjWuRtyvsNwlfEUMJtiA44WXcjrXxiXwn8OeQZilJcd</recordid><startdate>19970601</startdate><enddate>19970601</enddate><creator>Cook, David J.</creator><creator>Proper, Jacqueline A.</creator><creator>Orszulak, Thomas A.</creator><creator>Daly, Richard C.</creator><creator>Oliver, William C.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19970601</creationdate><title>Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults</title><author>Cook, David J. ; Proper, Jacqueline A. ; Orszulak, Thomas A. ; Daly, Richard C. ; Oliver, William C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-6f7a21120f1a47d75ddc3fd487a6fca26f0e8288ee5802681a54bad81c05b3763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Anesthetics, Inhalation - blood</topic><topic>Anesthetics, Intravenous - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Brain - metabolism</topic><topic>Carbon Dioxide - blood</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiopulmonary Bypass - instrumentation</topic><topic>cardiopulmonarybypass flow rate</topic><topic>cerebral blood flow</topic><topic>cerebral metabolic rate</topic><topic>Cerebrovascular Circulation</topic><topic>Fentanyl - administration & dosage</topic><topic>Hemodilution</topic><topic>Hemoglobins - analysis</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Hypothermia, Induced</topic><topic>Kety-Schmidt technique</topic><topic>Medical sciences</topic><topic>Midazolam - administration & dosage</topic><topic>Nitrous Oxide - blood</topic><topic>Oxygen - blood</topic><topic>Oxygen Consumption</topic><topic>Prospective Studies</topic><topic>Rheology</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Veins</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cook, David J.</creatorcontrib><creatorcontrib>Proper, Jacqueline A.</creatorcontrib><creatorcontrib>Orszulak, Thomas A.</creatorcontrib><creatorcontrib>Daly, Richard C.</creatorcontrib><creatorcontrib>Oliver, William C.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cook, David J.</au><au>Proper, Jacqueline A.</au><au>Orszulak, Thomas A.</au><au>Daly, Richard C.</au><au>Oliver, William C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults</atitle><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle><addtitle>J Cardiothorac Vasc Anesth</addtitle><date>1997-06-01</date><risdate>1997</risdate><volume>11</volume><issue>4</issue><spage>415</spage><epage>419</epage><pages>415-419</pages><issn>1053-0770</issn><eissn>1532-8422</eissn><abstract>Objective:
The purpose of this study was to examine the effect of cardiopulmonary bypass flow rate on cerebral blood flow and cerebral metabolic rate for oxygen during hypothermic (27°C) cardiopulmonary bypass.
Design, Setting, and Participants:
The investigation was a prospective, randomized study in a tertiary care hospital setting. The 30 participants were volunteer adult cardiac surgical patients at a single institution.
Interventions:
The N20 saturation method of Kety and Schmidt was used to determine global cerebral blood flow and metabolic rate during four periods: prebypass, cardiopulmonary bypass (CPB) (27°C) flow rates of 2.3 and 1.2 L/min/m
2, and 30 minutes post-CPB. Anesthesia consisted of fentanyl and midazolam; pH management was a-stat, and mean arterial pressure was maintained at 50 to 70 mmHg throughout CPB.
Measurements and Main Results:
In the context of an unchanged mean arterial pressure, the pump flow did not affect cerebral blood flow or metabolic rate during hypothermic CPB. Systemic venous oxygen saturation was also maintained during reduced flow at 27°C. Hemodilution during hypothermic CPB maintained cerebral blood flow at prebypass levels. In the postbypass period, persistent hemodilution resulted in an elevated cerebral blood flow.
Conclusions:
Brain oxygenation is well maintained at lower than conventional pump flow levels during CPB. There may be practical advantages to reduced flows during hypothermia, and flow reductions do not appear to adversely affect cerebral blood flow or metabolism.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>9187987</pmid><doi>10.1016/S1053-0770(97)90047-1</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1053-0770 |
| ispartof | Journal of cardiothoracic and vascular anesthesia, 1997-06, Vol.11 (4), p.415-419 |
| issn | 1053-0770 1532-8422 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_79064017 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Anesthetics, Inhalation - blood Anesthetics, Intravenous - administration & dosage Biological and medical sciences Blood Pressure Brain - metabolism Carbon Dioxide - blood Cardiac Surgical Procedures Cardiopulmonary Bypass - instrumentation cardiopulmonarybypass flow rate cerebral blood flow cerebral metabolic rate Cerebrovascular Circulation Fentanyl - administration & dosage Hemodilution Hemoglobins - analysis Humans Hydrogen-Ion Concentration Hypothermia, Induced Kety-Schmidt technique Medical sciences Midazolam - administration & dosage Nitrous Oxide - blood Oxygen - blood Oxygen Consumption Prospective Studies Rheology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Veins |
| title | Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults |
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