Med Biol Eng Comput - Assessment of dynamic cerebral autoregulation and cerebral carbon dioxide reactivity during normothermic cardiopulmonary bypass.

Tópicos

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Resumo

Despite increased risk of neurological complications after cardiac surgery, monitoring of cerebral hemodynamics during cardiopulmonary bypass (CPB) is still not a common practice. Therefore, a technique to evaluate dynamic cerebral autoregulation and cerebral carbon dioxide reactivity (CO2R) during normothermic nonpulsatile CPB is presented. The technique uses continuous recording of invasive arterial blood pressure, middle cerebral artery blood flow velocity, absolute cerebral tissue oxygenation, in-line arterial carbon dioxide levels, and pump flow measurement in 37 adult male patients undergoing elective CPB. Cerebral autoregulation is estimated by transfer function analysis and the autoregulation index, based on the response to blood pressure variation induced by cyclic 6/min changes of indexed pump flow from 2.0 to 2.4 up to 2.8 L/min/m(2). CO2R was calculated from recordings of both cerebral blood flow velocity and cerebral tissue oxygenation. Cerebral autoregulation and CO2R were estimated at hypocapnia, normocapnia, and hypercapnia. CO2R was preserved during CPB, but significantly lower for hypocapnia compared with hypercapnia (p < 0.01). Conversely, cerebral autoregulation parameters such as gain, phase, and autoregulation index were significantly higher (p < 0.01) during hypocapnia compared with both normocapnia and hypercapnia. Assessing cerebral autoregulation and CO2R during CPB, by cyclic alteration of pump flow, showed an impaired cerebral autoregulation during hypercapnia.

Resumo Limpo

despit increas risk neurolog complic cardiac surgeri monitor cerebr hemodynam cardiopulmonari bypass cpb still common practic therefor techniqu evalu dynam cerebr autoregul cerebr carbon dioxid reactiv cor normotherm nonpulsatil cpb present techniqu use continu record invas arteri blood pressur middl cerebr arteri blood flow veloc absolut cerebr tissu oxygen inlin arteri carbon dioxid level pump flow measur adult male patient undergo elect cpb cerebr autoregul estim transfer function analysi autoregul index base respons blood pressur variat induc cyclic min chang index pump flow lminm cor calcul record cerebr blood flow veloc cerebr tissu oxygen cerebr autoregul cor estim hypocapnia normocapnia hypercapnia cor preserv cpb signific lower hypocapnia compar hypercapnia p convers cerebr autoregul paramet gain phase autoregul index signific higher p hypocapnia compar normocapnia hypercapnia assess cerebr autoregul cor cpb cyclic alter pump flow show impair cerebr autoregul hypercapnia

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