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Title: A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac Surgery With Cardiopulmonary Bypass.
Austin Authors: Chan, Matthew J;Lucchetta, Luca;Cutuli, Salvatore L ;Eyeington, Christopher T;Glassford, Neil J;Mårtensson, Johan;Angelopoulos, Peter;Matalanis, George ;Weinberg, Lawrence;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiac Perfusion, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Nov-2019
Date: 2019-03-08
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2019; 33(11): 2968-2978
Abstract: To test whether targeted therapeutic mild hypercapnia (TTMH) would attenuate cerebral oxygen desaturation detected using near-infrared spectroscopy during cardiac surgery requiring cardiopulmonary bypass (CPB). Randomized controlled trials. Operating rooms and intensive care unit of tertiary hospital. The study comprised 30 patients undergoing cardiac surgery with CPB. Patients were randomly assigned to receive either standard carbon dioxide management (normocapnia) or TTMH (target arterial carbon dioxide partial pressure between 50 and 55 mmHg) throughout the intraoperative period and postoperatively until the onset of spontaneous ventilation. Relevant biochemical and hemodynamic variables were measured, and cerebral tissue oxygen saturation (SctO2) was monitored with near-infrared spectroscopy. Patients were followed-up with neuropsychological testing. Patient demographics between groups were compared using the Fisher exact and Mann-Whitney tests, and SctO2 between groups was compared using repeated measures analysis of variance. The median patient age was 67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II was 1.1. The median CPB time was 106 minutes. The mean intraoperative arterial carbon dioxide partial pressure for each patient was significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg [IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9 mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004). There was no difference in mean percentage change in SctO2 during CPB in the control group for both hemispheres (left: -6.7% v -2.3%; p = 0.110; right: -7.9% v -1.0%; p = 0.120). Compliance with neuropsychological test protocols was poor. However, the proportion of patients with drops in test score >20% was similar between groups in all tests. TTMH did not increase SctO2 appreciably during CPB but increased pulmonary artery pressures before and after CPB. These findings do not support further investigation of TTMH as a means of improving SctO2 during and after cardiac surgery requiring CPB.
DOI: 10.1053/j.jvca.2019.03.012
ORCID: 0000-0002-1650-8939
Journal: Journal of Cardiothoracic and Vascular Anesthesia
PubMed URL: 31072710
Type: Journal Article
Subjects: cardiac surgery
cardiopulmonary bypass
near-infrared spectroscopy
neuropsychological testing
pulmonary artery pressure
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