PMID- 19766503
OWN - NLM
STAT- MEDLINE
DCOM- 20110119
LR  - 20161125
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 37
IP  - 3
DP  - 2010 Mar
TI  - Influence of two perfusion strategies on oxygen metabolism in paediatric cardiac 
      surgery. Evaluation of the high-flow, low-resistance technique.
PG  - 651-7
LID - 10.1016/j.ejcts.2009.07.050 [doi]
AB  - OBJECTIVE: Paediatric cardiac surgery is often performed under hypothermic 
      conditions, that is, with a reduced core body temperature. Certain interventions 
      even require the circulation to be stopped. This can only be done at a body 
      temperature of 18 degrees C, with no risk of neurological damage and harm to the 
      brain and other organs. Vasoconstriction is a natural reaction of the body to 
      cold, causing the blood vessels to contract. Such a reaction would lead to a 
      clear rise in blood pressure on cardiopulmonary bypass (CPB). Since the blood 
      pressure is regulated in the arteriolar loop of the capillary system, there is a 
      marked increase in blood pressure and a suppression of free water into the 
      surrounding tissue, which, in turn, may lead to the intra-operative development 
      of oedemas. This study aimed to investigate whether the high-flow, low-resistance 
      (HFLR) technique offers any benefits over conventional methods. METHOD: This 
      open, prospective, randomised study was to recruit 48 children scheduled to 
      undergo surgery for congenital heart disease. To investigate the two different 
      perfusion strategies, we have measured intestinal perfusion as well as skin 
      perfusion with laser Doppler spectroscopy. To identify the effects on the immune 
      system, selected immunologic parameters of systemic inflammation were 
      additionally measured. Laser Doppler spectroscopy is a method that uses a glass 
      fibre probe to determine the parameters of oxygen saturation of haemoglobin and 
      relative haemoglobin quantity in an illuminated tissue volume, as well as the 
      perfusion parameters of relative blood flow and blood flow velocity in the sample 
      volume of the probe. RESULTS: During the study period, the change in oxygen 
      saturation over time was comparable in both groups. At the end of surgery, the 
      patients of the high-flow group had significantly higher saturation levels in the 
      intestinal mucosa (p<0.05). Over the course of intensive care, the groups did not 
      differ in terms of fluid supply, administration of packed red blood cells, 
      platelet concentrates or fresh frozen plasma. Analysis of urinary output revealed 
      significant group differences. It was higher in the patients of the high-flow 
      group than the normal-flow group (p<0.03), without differences in diuretic 
      administration. CONCLUSION: Laser Doppler spectroscopy is highly suited to the 
      detection even of the slightest changes in flow characteristics and oxygenation 
      of the skin, musculature and intestinal mucosa during surgery with extracorporeal 
      circulation using CPB. At the same time, the technique of HFLR perfusion was 
      found to have benefits over conventional bypass methods.
CI  - Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Schindler, Ehrenfried
AU  - Schindler E
AD  - Department of Pediatric Cardiac Anesthesiology, Congenital Cardiac Center, 
      Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany. 
      e.schindler@asklepios.com
FAU - Photiadis, Joachim
AU  - Photiadis J
FAU - Lagudka, Stefan
AU  - Lagudka S
FAU - Fink, Christoph
AU  - Fink C
FAU - Hraska, Victor
AU  - Hraska V
FAU - Asfour, Boulos
AU  - Asfour B
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090919
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Hemoglobins)
RN  - 0 (Interleukin-6)
RN  - 0 (Interleukin-8)
RN  - 0 (Protein Precursors)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 9007-12-9 (Calcitonin)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Calcitonin/blood
MH  - Cardiopulmonary Bypass/*methods
MH  - Heart Defects, Congenital/*surgery
MH  - Hemoglobins/metabolism
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Interleukin-6/blood
MH  - Interleukin-8/blood
MH  - Intestinal Mucosa/blood supply
MH  - Laser-Doppler Flowmetry/methods
MH  - Oxygen/blood
MH  - Oxygen Consumption/*physiology
MH  - Protein Precursors/blood
MH  - Regional Blood Flow
MH  - Skin/blood supply
MH  - Tumor Necrosis Factor-alpha/blood
EDAT- 2009/09/22 06:00
MHDA- 2011/01/20 06:00
CRDT- 2009/09/22 06:00
PHST- 2009/02/17 00:00 [received]
PHST- 2009/07/01 00:00 [revised]
PHST- 2009/07/31 00:00 [accepted]
PHST- 2009/09/22 06:00 [entrez]
PHST- 2009/09/22 06:00 [pubmed]
PHST- 2011/01/20 06:00 [medline]
AID - S1010-7940(09)00861-6 [pii]
AID - 10.1016/j.ejcts.2009.07.050 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2010 Mar;37(3):651-7. doi: 10.1016/j.ejcts.2009.07.050. 
      Epub 2009 Sep 19.