Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : April | Volume : 11 | Issue : 4 | Page : UC22 - UC25

Monitoring Microcirculatory Blood Flow during Cardiopulmonary Bypass in Paediatric Cardiac Surgery Patients as a Predictor for Anaerobic Metabolism

Ramesh Patel, Atul Solanki, Hasmukh Patel, Jignesh Patel, Himani Pandya, Jainam Sharma

1. Professor and Head, Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India. 2. Chief Perfusionist, Department of Perfusion, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India. 3. Resident, Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India. 4. Perfusionist, Department of Perfusion, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India. 5. Research Associate, Department of Research, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India. 6. Postgraduate Student, Department of Perfusion, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.

Correspondence Address :
Dr. Ramesh Patel,
Professor and Head, Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center,
Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.
E-mail: dr.ramesh33@gmail.com

Abstract

Introduction: Improving tissue oxygenation is one of most important tasks in management of low cardiac output. Central venous oxygen saturation (ScvO2) and lactate are established criteria for monitoring the adequacy of tissue oxygenation. The venous-to-arterial carbon dioxide difference [P(v-a)CO2] is inversely associated with cardiac output.

Aim: To study the use of P(v-a)CO2/C(a-v)O2 ratio as a marker of low cardiac output during Cardiopulmonary Bypass (CPB) in paediatric cardiac surgical patients.

Materials and Methods: The present study was a prospective observational study conducted over a period of nine months from 1st August 2015 to 30th April 2016. A total of 110 children were enrolled, who underwent CPB during cardiac surgery. The CPB time, Mean Arterial Pressure (MAP), flow rate, cross clamp time, were recorded for all the patients as well as Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) were checked at four different points of time: 1) Before CPB, 2) 10 minutes after initiation of CPB, 3) 30 minutes on CPB and 4) off CPB.

Results: The results indicated that Receiver Operating Characteristic curve (ROC curve) at 30 minute of CPB time P(v-a)CO2/C(a-v)O2 was more specific and sensitive than lactate to detect anaerobic metabolism. Decrease platelet count was significant on second postoperative day.

Conclusion: The present study suggests the use of P(v-a)CO2/C(a-v)O2 ratio as a marker to detect low flow on CPB. Our study was single centric and with a small size, studies involving large population and multiple centers are required to support the recent findings.

Keywords

Arterial blood gas, Central venous oxygen saturation, Venous blood gas

How to cite this article :

Ramesh Patel, Atul Solanki, Hasmukh Patel, Jignesh Patel, Himani Pandya, Jainam Sharma. MONITORING MICROCIRCULATORY BLOOD FLOW DURING CARDIOPULMONARY BYPASS IN PAEDIATRIC CARDIAC SURGERY PATIENTS AS A PREDICTOR FOR ANAEROBIC METABOLISM. Journal of Clinical and Diagnostic Research [serial online] 2017 April [cited: 2017 Jun 25 ]; 11:UC22-UC25. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=April&volume=11&issue=4&page=UC22-UC25&id=9721

DOI and Others

DOI: 10.7860/JCDR/2017/24360.9721


Date of Submission: Sep 23, 2016
Date of Peer Review: Oct 22, 2016
Date of Acceptance: Feb 05, 2017
Date of Publishing: Apr 01, 2017


Financial OR OTHER COMPETING INTERESTS: None.

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