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

• Published in: Intensive care medicine Vol. 38; no. 3; pp. 413 - 421
• Main Authors: De Blasi, R. A., Tonelli, E., Arcioni, R., Mercieri, M., Cigognetti, L., Romano, R., Pinto, G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2012; Springer; Springer Nature B.V
• Subjects: Academic Medical Centers; Aged; Analysis of Variance; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Blood; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Coronary artery bypass; Critical Care Medicine; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medicine; Female; Hemodilution - methods; Hemoglobin; Humans; Infrared spectroscopy; Intensive; Intensive care; Intensive care medicine; Internet resources; Italy; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Metabolism; Microcirculation - physiology; Mortality; Muscle, Skeletal - blood supply; Muscle, Skeletal - metabolism; Muscles; Musculoskeletal system; Observational studies; Original; Oxygen Consumption - physiology; Oxyhemoglobin; Pain Medicine; Pediatrics; Perioperative Care - methods; Physiological aspects; Pneumology/Respiratory System; Spectroscopy, Near-Infrared; Spectrum analysis; Statistics, Nonparametric; Surgery; Temperature; Variables; Italy; Cardiopulmonary bypass; Microcirculation; Oxygen delivery; Skeletal muscle; Near-infrared spectroscopy; Human; Oxygen; Intensive care; Striated muscle; Metabolism; Near infrared spectrometry; Hemodilution; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-011-2404-0

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 ([HbO 2 ], [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 (mVO 2 ) 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.