An Analysis of Oxygen Consumption and Oxygen Delivery in Euthermic Infants After Cardiopulmonary Bypass With Modified Ultrafiltration

• Published in: The Annals of thoracic surgery Vol. 78; no. 4; pp. 1389 - 1396
• Main Authors: Li, Jia, Hoschtitzky, Andreas, Allen, Meredith L., Elliott, Martin J., Redington, Andrew N.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2004; Elsevier Science
• Subjects: Biological and medical sciences; Body Temperature; Cardiac Output, Low - blood; Cardiac Output, Low - physiopathology; Cardiopulmonary Bypass - methods; Cytokines - blood; Delivery. Postpartum. Lactation; Female; Gynecology. Andrology. Obstetrics; Heart Defects, Congenital - surgery; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Interleukin-6 - blood; Interleukin-8 - blood; Lactates - blood; Male; Medical sciences; Organophosphates - administration & dosage; Oxygen - blood; Oxygen Consumption; Postoperative Complications - blood; Postoperative Complications - physiopathology; Postoperative Period; Premedication; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Systemic Inflammatory Response Syndrome - prevention & control; Tumor Necrosis Factor-alpha - analysis; Ultrafiltration; 25; Human; Cardiopulmonary bypass; Treatment; Ultrafiltration; Respiratory disease; Analysis; Surgery; Oxygen consumption; Infant; Thorax; Delivery
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2004.02.032

The balance between systemic oxygen consumption (V̇O 2) and delivery (DO 2) is impaired after cardiopulmonary bypass (CPB) and is related to systemic inflammatory response syndrome. We sought to assess V̇O 2 and DO 2 and their relationship with proinflammatory cytokines after CPB with the use of modified ultrafiltration (MUF) in infants. Sixteen infants, aged 1–11.5 months (median, 6.3 months), undergoing hypothermic CPB with MUF were studied during the first 12 hours after arrival in the intensive care unit (ICU). The central temperature was maintained at 36.8–37.1°C using external cooling or warming. V̇O 2 was continuously measured using respiratory mass spectrometry. Arterial blood samples for the tumor necrosis factor (TNF), interleukin-6 (IL-6), and interleukin-8 (IL-8) were taken and DO 2 was calculated using the Fick principle on arrival at the ICU, and 2, 4, 8, and 12 hours postoperatively. Cytokines were additionally measured after induction of anesthesia and at the end of MUF. V̇O 2 significantly decreased by 18.8% during the study period. DO 2 was depressed throughout this period and reached a nadir at 8 hours (357.1 ± 136.2 ml · min −1 · m −2). The decrease in cytokines was accompanied with the decrease in V̇O 2 despite varied relationships between the levels of each of the cytokines and V̇O 2 measurements. Our data indicate an unusual continuous decrease in V̇O 2 during the first 12 hours after CPB in infants. Control of body temperature to maintain euthermia in addition to the use of MUF may be beneficial to the balance between V̇O 2 and DO 2 in the early postoperative period.