İlker YILDIRIM, Ayhan ŞAHİN, Onur BARAN, Cavidan ARAR, Mustafa GÜNKAYA, Ercan GÜNERİ

Kardiyopulmoner Bypass Hastalarında Pulsatil ve Pulsatil Olmayan Ekstra Korporeal Perfüzyonun Serebral Oksijen Satürasyonuna Etkisi (Akım Türünün Serebral Oksijenasyona Etkisi)

Amaç:Kalp akciğer makinesi tarafından oluşturulan akım türü kardiyopulmoner bypassta önemlidir. Kardiyopulmoner bypass sırasında pulsatil akıma karşı pulsatil olmayan akımın kullanılması klinisyenler arasında bir tartışma konusu olmuştur. Kardiyopulmoner bypass sırasında pulsatil olmayan ve pulsatil akımın serebral oksijenasyon üzerindeki etkisinikarşılaştırdık. Materyal ve Metot:Üniversite hastanemizde koroner arter bypass greft cerrahisi yapılan 50 erişkin hastanın pulsatil ve pulsatil olmayan akım tipi arasındaki serebral oksijenasyon farklarını karşılaştırmak için kullanılan yakın kızılötesi spektroskopi ile retrospektif bir çalışma yaptık. Bulgular:Pulsatil ve pulsatil olmayan akımın SpO2, pO2, pCO2 üzerindeki etkileri arasında anlamlı bir fark yoktu. Yakın Kızılötesi Spektroskopisi verilerinde her iki akım türü arasında anlamlı bir fark yoktu. Sonuç:Erişkin hastalarda kalp-akciğer makinesi (pulsatil veya pulsatil olmayan) tarafından üretilen akım tipinin serebral oksijenasyona etkisi yoktu.

THE EFFECT OF PULSATILE AND NON-PULSATILE EXTRA CORPOREAL PERFUSION ON CEREBRAL OXYGEN SATURATION IN CARDIOPULMONARY BYPASS PATIENTS (FLOW TYPE ON CEREBRAL OXYGENATION)

Aim:The flow type generated by a heart-lung machine is important in cardiopulmonary bypass. The use of pulsatile flow versus non- pulsatile flow during cardiopulmonary bypass has been a controversy among clinicians. We compared the effect of non- pulsatile and pulsatile flow during cardiopulmonary bypass on cerebral oxygenation.Materials and Methods:Weconducted a retrospective study of 50 adult patients who underwent coronary artery bypass graft surgery at our university hospital, with near infrared spectroscopy used to compare differences in cerebral oxygenation between the pulsatile and non-pulsatile flow type.Results:There was no difference between the effect of pulsatile and non-pulsatile flow on the saturation of hemoglobin (SpO2), nor on the partial pressure of oxygen (pO2) and carbon dioxide (pCO2). The near infrared spectroscopy results were not different between the two flowtypes.Conclusion:There was no effect of the flow type generated by a heart-lung machine (pulsatile or non-pulsatile) on cerebral oxygenation in adult patients.

PDF

___

1. Ozturk S, Sacar M, Baltalarli A, Ozturk I. Effect of the type of cardiopulmonary bypass pump flow on postoperative cognitive function in patients undergoing isolated coronary artery surgery. Anatol J Cardiol. 2016(11);16:875-880.
2. Taylor KM, Bain WH, Davidson KG, Turner MA. Comparative clinical study of pulsatile and non- pulsatile perfusion in 350 consecutive patients. Thorax. 1982;37(5):324-330.
3. Baraki H, Gohrbandt B, Del Bagno B, Haverich A, Boethig D, Kutschka I. Does pulsatile perfusion improve outcome after cardiac surgery? a propensity- matched analysis of 1959 patients. Perfusion. 2012;27(3):166-74.
4. Ji B, Undar A. An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and adult cardiac patients. ASAIO J.2006;52(4):357-61.
5. Grubhofer G, Mares P, Rajek A, Mullner T, Haisjackl M, Dworschak M, et al. Pulsatility does not change cerebral oxygenation during cardiopulmonary bypass. Acta anaesthesiologica Scandinavica. 2000;44(5):586- 91.
6. Tovedal T, Thelin S, Lennmyr F. Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis. Perfusion.2016;31(1):72-77.
7. O'Neil MP, Fleming JC, Badhwar A, Guo LR. Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Ann Thorac Surg.2012;94(6):2046-53.
8. Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia and analgesia.2007;104(1):51-8.
9. Steppan J, HogueCWJr. Cerebral and tissue oximetry. Best Pract Res Clin Anaesthesiol. 2014;28(4):429-39.
10. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. British journal of anaesthesia. 2009;103 Suppl1:i3-13.
11. Toet MC, Lemmers PM. Brain monitoring in neonates. Early Hum Dev. 2009;85(2):77-84.
12. Morgan GE, Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's clinical anesthesiology(6th.Edi.). Mc Graw Hill Education,NewYork.2018.
13. Hickey PR, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy. Ann Thorac Surg. 1983;36(6):720-37.
14. Onorati F, Santarpino G, Presta P, Caroleo S, Abdalla K, Santangelo E, et al. Pulsatile perfusion with intra- aortic balloon pumping ameliorates whole body response to cardiopulmonary bypass in the elderly. Crit Care Med.2009;37(3):902-11.
15. Presta P, Onorati F, Fuiano L, Mastroroberto P, Santarpino G, Tozzo C, et al. Can pulsatile cardiopulmonary bypass prevent perioperative renal dysfunction during myocardial revascularization in elderly patients? Nephron Clin Pract. 2009;111(4):c229-35.
16. Su XW, Guan Y, Barnes M, Clark JB, Myers JL, Undar A. Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass. Pediatr Res. 2011;70(2):181-5.
17. Undar A. The ABCs of research on pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass. Medical science monitor : international medical journal of experimental and clinical research. 2002;8(12):ED21-4.
18. Abramov D, Tamariz M, Serrick CI, Sharp E, Noel D, Harwood S, et al. The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients. Can J Cardiol. 2003;19(3):237-43.
19. Zhao J, Yang J, Liu J, Li S, Yan J, Meng Y, et al. Effects of pulsatile and nonpulsatile perfusion on cerebral regional oxygen saturation and endothelin-1 in tetralogy of fallot infants. Artif Organs. 2011;35(3):E54-8.
20. Kim HK, Son HS, Fang YH, Park SY, Hwang CM,Sun K. The effects of pulsatile flow upon renal tissue perfusion during cardiopulmonary bypass: a comparative study of pulsatile and nonpulsatile flow. ASAIO J. 2005;51(1):30-6.
21. Poswal P, Mehta Y, Juneja R, Khanna S, Meharwal ZS, Trehan N. Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann Card Anaesth. 2004;7(1):44-50.associatedhepatocellular carcinoma. J Gastroenterol Hepatol. 2016;31(10):1766-72.
22. LiMX,Zhao H, Bi XY, Li ZY, Huang Z, Han Y, et al. Prognostic value of the albumin–bilirubin grade in patients with hepatocellular carcinoma: Validation in a Chinese cohort. Hepatology Research. 2017; 47(8): 731–41.
23. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424.
24. Carr BI. Hepatocellular carcinoma: current management and future trends. Gastroenterology. 2004;127(5 Suppl1):S218–24.
25. Ho CHM, Chiang CL, Lee FAS, Choi HCW, Chan JCH, Yeung CSY, et al. Comparison of platelet- albumin-bilirubin (PALBI), albumin-bilirubin(ALBI), and child-pugh (CP) score for predicting of survival in advanced hcc patients receiving radiotherapy (RT). Oncotarget.2018;9(48): 28818-29.
26. Liu PH, Hsu CY, Hsia CY, Lee YH, Chiou YY, Huang YH, et al. ALBI and PALBI grade predict survival for HCC across treatment modalities and BCLC stages in the MELD Era. Journal of Gastroenterology and Hepatology 2017; 32: 879–86.
27. Hansmann J, Evers MJ, Bui JT, Lokken RP, Lipnik AJ, Gaba RC, et al. Albumin-Bilirubin and Platelet- Albumin-Bilirubin Grades Accurately Predict Overall Survival in High-Risk Patients Undergoing Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol. 2017 Sep;28(9):1224-31.
28. Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E, et al. Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer.2017;6(3):204-15.
29. Lee SK, Song MJ, Kim SH, Park M. Comparing various scoring system for predicting overall survival according to treatment modalities in hepatocellular carcinoma focused onplatelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grade: A nationwide cohort study. PLoS One. 2019;14(5):e0216173.
30. Lu LH, Zhang YF, Mu-Yan C, Kan A, Zhong XP, Mei J, et al. Platelet-albumin-bilirubin grade: Risk stratification of liver failure, prognosis after resection for hepatocellular carcinoma. Dig Liver
31. Elshaarawy O, Alkhatib A, Elhelbawy M, Gomaa A, Allam N, Alsebaey A, et al. Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma. World J Hepatol.2019;11(6):542-552.