Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T08:56:38.642Z Has data issue: false hasContentIssue false
  • English
  • Français

Critical oxygen delivery during cardiopulmonary bypass in dogs: pulsatile vs. non-pulsatile blood flow

Published online by Cambridge University Press:  23 December 2005

P. J. Van der Linden ,
S. G. De Hert ,
S. Belisle ,
G. Sahar ,
A. Deltell ,
Y. Bekkrar ,
M. Blauwaert  and
J.-L. Vincent
P. J. Van der Linden
Affiliation:
Charleroi University Hospital, Department of Cardiac Anaesthesia (now CHU-Brugmann, Department of Anaesthesiology, Brussels), Charleroi, Belgium
S. G. De Hert
Affiliation:
Antwerp University Hospital, Department of Anaesthesiology, Edegem, Belgium
S. Belisle
Affiliation:
Montreal Heart Institute, Department of Cardiac Anaesthesia, Montreal, Canada
G. Sahar
Affiliation:
Erasme University Hospital, Department of Cardiac Surgery, Brussels, Belgium
A. Deltell
Affiliation:
Erasme University Hospital, Department of Anaesthesiology, Brussels, Belgium
Y. Bekkrar
Affiliation:
Erasme University Hospital, Department of Anaesthesiology, Brussels, Belgium
M. Blauwaert
Affiliation:
Erasme University Hospital, Department of Anaesthesiology, Brussels, Belgium
J.-L. Vincent
Affiliation:
Erasme University Hospital, Department of Intensive Care, Brussels, Belgium
Get access

Extract

Summary

Background and objective: To determine the minimal oxygen delivery and pump flow that can maintain systemic oxygen uptake during normothermic (37°C) pulsatile and non-pulsatile cardiopulmonary bypass in dogs. Methods: Eighteen anaesthetized dogs were randomly assigned to receive either non-pulsatile (Group C; n = 9) or pulsatile bypass flow (Group P; n = 9). Oxygen delivery was reduced by a progressive decrease in pump flow, while arterial oxygen content was maintained constant. In each animal, critical oxygen delivery was determined from plots of oxygen uptake vs. oxygen delivery and from plots of blood lactate vs. oxygen delivery using a least sum of squares technique. Critical pump flow was determined from plots of lactate vs. pump flow. Results: At the critical point, oxygen delivery obtained from oxygen uptake was 7.7 ± 1.1 mL min−1 kg−1 in Group C and 6.8 ± 1.8 mL min−1 kg−1 in Group P (n.s.). These values were similar to those obtained from lactate measurements (Group C: 7.8 ± 1.6 mL min−1 kg−1; Group P: 7.6 ± 2.0 mL min−1 kg−1). Critical pump flows determined from lactate measurements were 55.6 ± 13.8 mL min−1 kg−1 in Group C and 60.8 ± 13.9 mL min−1 kg−1 in Group P (n.s.). Conclusions: Oxygen delivery values greater than 7–8 mL min−1 kg−1 were required to maintain oxygen uptake during normothermic cardiopulmonary bypass with either pulsatile or non-pulsatile blood flow. Elevation of blood lactate levels during bypass helps to identify inadequate tissue oxygen delivery related to insufficient pump flow.

Keywords

CARDIOPULMONARY BYPASS, pump flowOXYGEN DELIVERYOXYGEN CONSUMPTIONLACTATES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 10 - 16
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schumacker PT, Cain SM. The concept of a critical oxygen delivery. Intens Care Med 1987; 13: 223–229.Google Scholar
Cain SM. Acute lung injury. Assesment of tissue oxygenation. Crit Care Clin 1986; 2: 537–550.Google Scholar
Mangano CM, Hill L, Cartwright CR, Hindman BJ. Cardiopulmonary bypass and the anesthesiologist. In: Kaplan JA, Reich DL, Konstadt SN, eds. Cardiac Anesthesia. Philadelphia: WB Saunders, 1999: 1061–1110.
Cavaliere F, Gennari A, Martinelli L, Zamparelli R, Schiavello R. The relationship between systemic oxygen uptake and delivery during moderate hypothermic cardiopulmonary bypass: critical values and effects of vasodilation by hydralazine. Perfusion 1995; 10: 315–321.Google Scholar
Van der Linden P, Schmartz D, De Groote F et al. Critical haemoglobin concentration in anaesthetized dogs: comparison of two plasma substitutes. Br J Anaesthesiol 1998; 81: 556–562.Google Scholar
Cain SM. Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol 1977; 42: 228–234.Google Scholar
Van der Linden P, Gilbart E, Engelman E, Schmartz D, Vincent JL. Effects of anesthetic agents on systemic critical O2 delivery. J Appl Physiol 1991; 71: 83–93.Google Scholar
Schlichtig R, Kramer DJ, Pinsky MR. Flow redistribution during progressive hemorrhage is a determinant of critical O2 delivery. J Appl Physiol 1991; 70: 169–178.Google Scholar
Nelson DP, Beyer C, Samsel RW, Wood LDH, Schumacker PT. Pathological supply dependence of O2 uptake during bacteremia in dogs. J Appl Physiol 1987; 63: 1487–1492.Google Scholar
Bredle DL, Samsel RW, Schumacker PT, Cain SM. Critical O2 delivery to skeletal muscle at high and low PO2 in endotoxemic dogs. J Appl Physiol 1989; 66: 2553–2558.Google Scholar
Hickey PR, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of counterproductive controversy. Ann Thorac Surg 1983; 36: 720–737.Google Scholar
Nakamura K, Harasaki H, Fukumura F, Fukamachi K, Whalen R. Comparison of pulsatile and non-pulsatile cardiopulmonary bypass on regional renal blood flow in sheep. Scand Cardiovasc J 2004; 38: 59–63.Google Scholar
Samsel RW, Schumacker PT. Determination of the critical O2 delivery from experimental data: sensitivity to error. J Appl Physiol 1988; 64: 2074–2082.Google Scholar
Zhang H, Smail N, Cabral A, Rogiers P, Vincent JL. Effects of norepinephrine on regional blood flow and oxygen extraction capabilities during endotoxic shock. Am J Respir Crit Care Med 1997; 155: 1965–1971.Google Scholar
Zhang H, DeJongh R, De Backer D, Cherkaoui S, Vray B, Vincent JL. Effects of alpha and beta adrenergic stimulation on hepatosplanchnic perfusion and oxygen extraction in endotoxic shock. Crit Care Med 2001; 29: 581–588.Google Scholar
Cilley RE, Scharenberg AM, Bongiorno PF, Guire KE, Barlett RH. Low oxygen delivery produced by anemia, hypoxia and low cardiac output. J Surg Res 1991; 51: 425–433.Google Scholar
Jan KM, Chien S. Effect of hematocrit variations on coronary hemodynamics and oxygen utilization. Am J Physiol 1977; 233: H106–H113.Google Scholar
Miller BE, Levy JH. The inflammatory response to cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11: 355–366.Google Scholar
Simmons DH, Alpas AP, Tashkin DP, Coulson A. Hyperlactatemia due to arterial hypoxemia, or reduced cardiac output, or both. J Appl Physiol 1978; 45: 195–202.Google Scholar
Cain SM. Appearance of excess lactate in anesthetized dogs during anemic and hypoxic hypoxia. Am J Physiol 1965; 209: 604–610.Google Scholar
Moss M, Moreau G, Lister G. Oxygen transport and metabolism in the conscious lamb. The effects of hypoxemia. Pediatr Res 1987; 22: 177–183.Google Scholar
Landow L. Splanchnic lactate production in cardiac surgery patients. Crit Care Med 1993; 21: S84–S91.Google Scholar
Wright G. Hemodynamic analysis could resolve the pulsatile blood flow controversy. Ann Thorac Surg 1994; 58: 1199–1204.Google Scholar
Wright G. Factors affecting the pulsatile hydraulic power output of the Stockert roller pump. Perfusion 1989; 4: 187–195.Google Scholar
Messmer K, Kreimeier U, Intaglietta M. Present state of intentional haemodilution. Eur Surg Res 1986; 18: 254–263.Google Scholar
Mirhashemi S, Messmer K, Intaglietta M. Tissue perfusion during normovolemic hemodilution investigated by a hydraulic model of the cardiovascular system. Int J Microcirc Clin Exp 1986; 6: 123–136.Google Scholar
Van der Linden P, Gilbart E, Paques P, Simon C, Vincent J-L. Influence of hematocrit on tissue O2 extraction capabilities in anesthetized dogs during acute hemorrhage. Am J Physiol 1993; 264: H1942–H1947.Google Scholar
Creteur J, Sun Q, Abid O, De Backer D, Van Der Linden P, Vincent JL. Normovolemic hemodilution improves oxygen extraction capabilities in endotoxic shock. J Appl Physiol 2001; 91: 1701–1707.Google Scholar
Liam BL, Plöchl W, Cook DJ, Orszulak TA, Daly RC. Hemodilution and whole oxygen balance during normothermic cardiopulmonary bypass in dogs. J Thorac Cardiovasc Surg 1998; 115: 1203–1208.Google Scholar
Sinard JM, Vyas D, Hultquist K, Harb J, Bartlett RH. Effects of moderate hypothermia on O2 consumption at various O2 deliveries in a sheep model. J Appl Physiol 1992; 72: 2428–2434.Google Scholar
Cain SM, Bradley WE. Critical O2 transport values at lowered body temperatures in rats. J Appl Physiol 1983; 55: 1713–1717.Google Scholar
Willford DC, Hill EP, White FC, Moores WY. Decreased critical mixed venous oxygen tension and critical oxygen transport during induced hypothermia in pigs. J Clin Monit 1986; 2: 165–168.Google Scholar
Van der Linden P, De Groote F, Bélisle S, Mathieu N, Willaert P. Effects of hypothermia on tissue O2 extraction capabilities in dogs. Anesth Analg 1998; 86: S112.Google Scholar
Moreno LF, Stratton HH, Newell JC, Feustel PJ. Mathematical coupling of data: correction of a common error for linear calculations. J Appl Physiol 1986; 60: 335–343.Google Scholar
Boston US, Slater JM, Orszulak TA, Cook DJ. Hierarchy of regional oxygen delivery during cardiopulmonary bypass. Ann Thorac Surg 2001; 71: 260–264.Google Scholar