Document Detail


Identification of pressure passive cerebral perfusion and its mediators after infant cardiac surgery.
MedLine Citation:
PMID:  15531739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cerebrovascular pressure autoregulation (CPA) regulates cerebral blood flow (CBF) in relation to changes in mean arterial blood pressure (MAP). Identification of a pressure-passive cerebral perfusion and the potentially modifiable physiologic factors underlying it has been difficult to achieve in sick infants. We previously validated the near-infrared spectroscopy-derived hemoglobin difference (HbD) signal (cerebral oxyhemoglobin - deoxyhemoglobin) as a reliable measure of changes in CBF in animal models. We now sought to determine whether continuous measurements of DeltaHbD would correlate to middle cerebral artery flow velocity (CBFV), allow identification and quantification of pressure-passive state, and help to delineate potentially modifiable factors. We enrolled 43 infants (2 d to 7 mo old) who were undergoing open cardiac surgery and cardiopulmonary bypass. At 6 and 20 h after surgery, we measured changes in HbD, CBFV (by transcranial Doppler), and MAP at different end-tidal CO(2) levels. We assigned a pressure-passive index (PPI) to each study on the basis of the relative duration of significant coherence between DeltaMAP and DeltaHbD. We found a significant relationship between DeltaHbD and DeltaCBFV at both time points. At 6 h after surgery, we showed high concordance (coherence > 0.5; PPI > or = 41%) between DeltaMAP and DeltaHbD, consistent with disturbed CPA in 13% of infants. End-tidal CO(2) values > or = 40 mm Hg and higher MAP variability both were associated with increased odds (p < 0.001) of autoregulatory failure. This approach provides a means to identify and quantify disturbances of CPA. High CO(2) levels and fluctuating MAP are two important preventable factors associated with disturbed CPA.
Authors:
Haim Bassan; Kimberlee Gauvreau; Jane W Newburger; Miles Tsuji; Catherine Limperopoulos; Janet S Soul; Gene Walter; Peter C Laussen; Richard A Jonas; Adré J du Plessis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2004-11-05
Journal Detail:
Title:  Pediatric research     Volume:  57     ISSN:  0031-3998     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-04     Completed Date:  2005-05-12     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-41     Citation Subset:  IM    
Affiliation:
Department of Neurology, Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure
Carbon Dioxide / metabolism
Cardiopulmonary Bypass*
Cerebrovascular Circulation / physiology*
Female
Hemoglobins / metabolism
Humans
Infant
Infant, Newborn
Male
Odds Ratio
Oxyhemoglobins / metabolism
Perfusion
Postoperative Period
Pressure
Spectrophotometry, Infrared
Time Factors
Ultrasonography, Doppler, Transcranial
Grant Support
ID/Acronym/Agency:
HL 063411/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Oxyhemoglobins; 124-38-9/Carbon Dioxide; 9008-02-0/deoxyhemoglobin
Comments/Corrections
Comment In:
Pediatr Res. 2005 May;57(5 Pt 1):749; author reply 749   [PMID:  15817492 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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