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Lower limit of adequate oxygen delivery for the maintenance of aerobic metabolism during cardiopulmonary bypass in neonates.
British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2020-02-05 , DOI: 10.1016/j.bja.2019.12.034
Mirela Bojan 1 , Enza Gioia 2 , Federica Di Corte 2 , Ilham Berkia 3 , Tiffany Tourneur 3 , Laurent Tourneur 3 , Filip De Somer 4
Affiliation  

BACKGROUND The objective of cardiopulmonary bypass (CPB) is to maintain an adequate balance between oxygen delivery (Ḋo2) and consumption. The critical Ḋo2 is that at which consumption becomes supply dependent. This study aimed to identify the critical Ḋo2 in neonates, who have higher metabolic rates than adults. METHODS In a retrospective cohort of neonates, Ḋo2 was calculated from CPB parameters recorded during aortic cross-clamping. High lactate concentration measured after aortic unclamping (lactOFF) was used to identify anaerobic metabolism. Data were analysed using mixed linear and proportional odds regression models. The relationship between Ḋo2 and temperature was analysed in a subgroup of patients with lactOFF <2.5 mM, thought to have had balanced oxygen delivery and consumption. The estimated regression coefficient was further used to adjust hypothetical Ḋo2 thresholds, and Ḋo2 excursions below the threshold were quantified as magnitude-durations. The lowest threshold that provided magnitude-durations and linked with an increase in lactOFF was used as the lowest suitable (critical) Ḋo2 at 37°C. RESULTS Overall, 22 896 time points were analysed in 180 neonates. In 40 patients with lactOFF <2.5 mM, Ḋo2 varied by 22.87 (0.70) ml min-1 m-2 °C-1. When varying the Ḋo2 threshold between 340 and 380 ml min-1 m-2, excursions below the threshold were linked with incremental lactOFF. A 100 ml m-2 excursion below the 340 ml min-1 m-2Ḋo2 threshold increased the risk of a 1 mM increment in lactOFF by 22% (odds ratio: 1.22; 95% confidence interval: 1.02-1.45). CONCLUSIONS It was found that 340 ml min-1 m-2 is likely to represent the lowest suitable Ḋo2 required in neonates to maintain aerobic metabolism during normothermic CPB.

中文翻译:

新生儿体外循环期间维持有氧代谢所需的充足氧气下限。

背景技术体外循环(CPB)的目的是在氧气输送(Ḋo2)和消耗之间保持适当的平衡。临界Ḋo2是消耗取决于供应的情况。这项研究旨在确定代谢率高于成人的新生儿中的临界Ḋ2。方法在回顾性的队列研究中,根据主动脉钳夹过程中记录的CPB参数计算Ḋo2。主动脉放松后测量的高乳酸浓度(lactOFF)用于鉴定厌氧代谢。使用混合线性和比例赔率回归模型分析数据。分析了aoOFF <2.5 mM的亚组患者中Ḋo2与体温之间的关系,这些患者被认为平衡了氧气的输送和消耗。估计的回归系数进一步用于调整假设的Ḋo2阈值,低于该阈值的Ḋo2偏移被量化为幅度持续时间。提供幅值持续时间并与lactOFF增加相关的最低阈值被用作37°C时最低的合适(临界))o2。结果总共对180例新生儿进行了22 896个时间点的分析。在40例lactOFF <2.5 mM的患者中,Ḋo2的变化范围为22.87(0.70)ml min-1 m-2°C-1。当在340 ml和380 ml min-1 m-2之间改变2o2阈值时,低于阈值的偏移与增加的lactOFF有关。低于340 ml min-1m-2Ḋo2阈值的100 ml m-2偏移将lactOFF增加1 mM的风险增加22%(几率:1.22; 95%置信区间:1.02-1.45)。
更新日期:2020-02-06
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