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Intensive Care Medicine

Published in:

01-03-2012 | Original

In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution

Authors: R. A. De Blasi, E. Tonelli, R. Arcioni, M. Mercieri, L. Cigognetti, R. Romano, G. Pinto

Published in: Intensive Care Medicine | Issue 3/2012

Abstract

Purpose

To investigate the in vivo effects of cardiopulmonary bypass (CPB) and perioperative hemodilution on human skeletal muscle oxygen delivery and metabolism and to determine the dilution state at which these effects arise.

Methods

We conducted this observational study in adult patients undergoing CPB surgery. Microcirculatory data were obtained by near-infrared spectroscopy from the brachioradial muscle in 20 consecutive patients undergoing hemodilution for CPB. Outcome variables included tissue oxy- and deoxyhemoglobin concentration ([HbO₂], [HHb]), oxygen content, blood flow, oxygen delivery, and oxygen consumption.

Results

Although CPB left tissue blood flow and oxygen delivery unchanged, both microcirculatory variables correlated significantly and inversely with hematocrit (Hct) (r = −0.39, p < 0.001; r = −0.50, p < 0.001). CPB also left muscle oxygen consumption (mVO₂) unchanged and this variable correlated with the tissue hemoglobin concentration and tissue oxygen delivery (r = 0.40, p = 0.001; r = 0.35, p = 0.005). During CPB most of the systemic cardiovascular variables remained unchanged. Conversely at Hct lower than 30%, mean arterial pressure and pH decreased and lactate values increased twofold, whereas microvascular blood volume and oxygen delivery increased. At Hct lower than 20% blood flow and oxygen delivery increased, whereas hemoglobin and oxygen content variables decreased.

Conclusions

CPB leaves skeletal muscle oxygen delivery and metabolism as measured by near-infrared spectroscopy unchanged. The only factor that correlates directly with the oxygen content variables and inversely with blood flow, and induces significant changes in tissue hemoglobin content and oxygen delivery, is hemodilution.

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Title: In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution
Authors: R. A. De Blasi
E. Tonelli
R. Arcioni
M. Mercieri
L. Cigognetti
R. Romano
G. Pinto
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 3/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2404-0

At a glance: The STEP trials

Springer Medicine

In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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