Dissociation Between Measures of Macrocirculation and Microcirculation in Patients Undergoing Cardiac Surgical Procedure

Abstract

BackgroundIn the postoperative period of cardiac surgical procedure, there is an imbalance in the ratio of oxygen supply to oxygen consumption that leads to organic dysfunction and death. There is evidence of microcirculation involvement in cardiac surgical procedure, and a dysregulated inflammatory response similar to sepsis can occur. MethodsWe present a cohort of 280 consecutive adults who were monitored in the postoperative period after cardiac surgical procedure. We performed serial measurements of macrocirculatory indices, indices of global oxygenation, CO2-derived indices, and perfusion indices in the first 24 hours postoperatively. ResultsWe identified a dissociation between circulatory macrohemodynamic parameters/global oxygenation indices and the CO2-derived indices. The CO2-derived indices constitute a surrogate for microcirculatory flow and indicate the presence of anaerobic metabolism. ConclusionsA better understanding of these clinical variables will help establish optimal management protocols. It will also aid in the identification of patients in subpopulations with organic dysfunction despite conventional circulatory parameters within normal limits who can be overlooked if this exhaustive hemodynamic evaluation is not performed.