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dc.contributor.authorMcNicol, Larryen
dc.contributor.authorLipcsey, Miklosen
dc.contributor.authorBellomo, Rinaldoen
dc.contributor.authorParker, Fen
dc.contributor.authorPoustie, Stephanie Jen
dc.contributor.authorLiu, Gen
dc.contributor.authorKattula, Aen
dc.identifier.citationBritish Journal of Anaesthesia 2013; 110(5): 721-8en
dc.description.abstractThe arterial pressure target for optimal splanchnic function during cardiopulmonary bypass (CPB) is uncertain. Thus, we aimed to compare the effects of two different arterial pressure targets during CPB on trans-splanchnic oxygenation, acid-base regulation, and splanchnic interleukin-6 (IL-6) and interleukin-10 (IL-10) flux.Sixteen patients undergoing cardiac surgery with CPB in a university affiliated hospital were subjected to a prospective alternating treatment design interventional study. We measured arterial and hepatic vein blood gases, electrolytes, IL-6, and IL-10 while targeting a mean arterial pressure (MAP) of between 60 and 65 mm Hg for 30 min, a MAP of between 80 and 85 mm Hg for 30 min (using norepinephrine infusion), and finally 60-65 mm Hg MAP target for 30 min.The MAP targets were achieved in all patients [65 (4), 84 (4), and 64 (3) mm Hg, respectively; P<0.001] with a greater dose of norepinephrine infusion during the higher MAP target (P<0.001). With longer time on CPB, hepatic vein O2 saturation decreased, while magnesium, lactate, glucose, IL-6, and IL-10 increased independent of MAP target. The decrease in hepatic vein saturation was greater as the temperature increased (re-warming). Overall, there was trans-splanchnic oxygen, chloride, lactate, and IL-6 removal during CPB (P<0.001) and carbon dioxide, bicarbonate, glucose, and IL-10 release (P<0.001). Such removal or release was not affected by the MAP target.Targeting of a higher MAP during CPB by means of norepinephrine infusion did not affect splanchnic oxygenation, splanchnic acid-base regulation, or splanchnic IL-6 or IL-10 fluxes. Australian and New Zealand Clinical Trial Registry ACTRN 12611001107910.en
dc.subject.otherAcid-Base Equilibrium.drug effects.physiologyen
dc.subject.otherAged, 80 and overen
dc.subject.otherArterial Pressure.drug effects.physiologyen
dc.subject.otherCarbon Dioxideen
dc.subject.otherCardiac Surgical Proceduresen
dc.subject.otherCardiopulmonary Bypassen
dc.subject.otherDose-Response Relationship, Drugen
dc.subject.otherHepatic Veins.metabolismen
dc.subject.otherIntraoperative Care.methodsen
dc.subject.otherMiddle Ageden
dc.subject.otherNorepinephrine.administration & dosage.pharmacologyen
dc.subject.otherPilot Projectsen
dc.subject.otherProspective Studiesen
dc.subject.otherSplanchnic Circulation.drug effects.physiologyen
dc.subject.otherVasoconstrictor Agents.administration & dosage.pharmacologyen
dc.titlePilot alternating treatment design study of the splanchnic metabolic effects of two mean arterial pressure targets during cardiopulmonary bypass.en
dc.typeJournal Articleen
dc.identifier.journaltitleBritish journal of anaesthesiaen
dc.identifier.affiliationDepartment of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC 3084,Australiaen
dc.type.austinJournal Articleen
item.fulltextNo Fulltext-
item.openairetypeJournal Article-
item.languageiso639-1en- Care- Analytics Research and Evaluation (DARE) Centre-
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