| Direct observation of the human microcirculation during cardiopulmonary bypass: effects of pulsatile perfusion. | |
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MedLine Citation:
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PMID: 20800509 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVES: Possible benefits of pulsatile perfusion during cardiopulmonary bypass often are attributed to enhanced microvascular flow. However, there is no evidence to support this in humans. Therefore, the authors assessed whether pulsatile perfusion alters human microvascular flow. DESIGN: A prospective, randomized observational crossover study. SETTING: A tertiary cardiothoracic surgery referral center. PARTICIPANTS: Sixteen patients undergoing routine cardiopulmonary bypass for cardiac surgery. INTERVENTIONS: All patients underwent both pulsatile and nonpulsatile perfusion in random order. MEASUREMENTS AND MAIN RESULTS: The authors used sidestream dark-field imaging to record video clips of the sublingual human microcirculation. Perfusion was started either in the pulsatile (n = 8) or the nonpulsatile mode. After 10 minutes, microvascular recordings were made. The perfusion mode was then switched, and after 10 minutes, new microvascular recordings were taken. The authors quantified pulsatile perfusion-generated surplus hemodynamic energy by calculating pulse pressure and energy-equivalent pressure. Microvascular analysis included determination of the perfused vessel density (mean ± standard deviation). This did not differ between nonpulsatile and pulsatile perfusion (6.65 ± 1.39 v 6.83 ± 1.23 mm(-1), p = 0.58, and 2.16 ± 0.64 v 1.96 ± 0.48 mm(-1), p = 0.20 for small and large microvessels, respectively, cutoff diameter = 20 μm). Pulse pressure and energy-equivalent pressure was higher during pulsatile perfusion. However, there was no correlation between the difference in energy-equivalent pressure or pulse pressure and perfused vessel density (r = -0.43, p = 0.13, and r = -0.09, p = 0.76, respectively). CONCLUSION: Pulsatile perfusion does not alter human microvascular perfusion using standard equipment in routine cardiac surgery. Changes in pulse pressure or energy-equivalent pressure bear no obvious relationship with microcirculatory parameters. |
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Authors:
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Paul W G Elbers; Jeroen Wijbenga; Frank Solinger; Aladdin Yilmaz; Mat van Iterson; Eric P A van Dongen; Can Ince |
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Publication Detail:
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Type: Journal Article Date: 2010-08-25 |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 25 ISSN: 1532-8422 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 250-5 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia, Intensive Care and Pain Management, St Antonius Hospital, Nieuwegein, The Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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