Abstract
BackgroundRecent scientific reports have brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The aim of our study was to analyse patients’ interim physiology while on cardiopulmonary bypass based on the haemodynamic and tissue oxygen delivery measurements. We also aimed to create a universal formula that may help in further implementation of the GDP concept.MethodsWe retrospectively analysed patients operated on at the Wroclaw University Hospital between June 2017 and December 2018. Since our observations provided an extensive amount of data, including the patients’ demographics, surgery details and the perfusion-related data, the Data Science methodology was applied.ResultsA total of 272 (mean age 62.5 ± 12.4, 74% male) cardiac surgery patients were included in the study. To study the relationship between haemodynamic and tissue oxygen parameters, the data for three different values of DO2i (280 ml/min/m2, 330 ml/min/m2 and 380 ml/min/m2), were evaluated. Each set of those lines showed a descending function of CI in Hb concentration for the set DO2i.ConclusionsModern calculation tools make it possible to create a common data platform from a very large database. Using that methodology we created models of haemodynamic compounds describing tissue oxygen delivery. The obtained unique patterns may both allow the adaptation of the flow in relation to the patient’s unique morphology that changes in time and contribute to wider and safer implementation of perfusion strategy which has been tailored to every patient’s individual needs.
Highlights
Recent scientific reports have brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized
New parameters determining adequate oxygen transport, such as percentage oxygen saturation of venous blood (SvO2), oxygen consumption (VO2), ratio of oxygen consumed to oxygen delivered (O2ER) and oxygen delivery indexed to body surface area to carbon dioxide production indexed to body surface area ratio (DO2i/VCO2i) were adopted
The formation of heterogeneous information derived from patient baseline characteristics along with operative details and the results of in-line real-time cardiopulmonary bypass (CPB) monitoring and pump flow rate measurements created a common platform for coherent multi-modal data processing
Summary
Recent scientific reports have brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The ECC procedure is associated with significant postoperative complications, occurring either de novo or as an Lukaszewski et al BMC Cardiovascular Disorders (2019) 19:292 the lack of EBM-based standards covering basic haemodynamic parameters, i.e., pump flow rate and perfusion pressure, as well as haemodilution range or indications for the vasoconstrictors use. The implementation of non-invasive real-time monitoring of oxygen transport and haemodynamics has become an intrinsic factor for the newly introduced concept, the so-called Goal-Directed Perfusion (GDP) The aim of this concept is to restore the physiological conditions of cell and tissue respiration during the ECC by optimizing both tissue oxygen delivery and extraction. The DO2i/VCO2i ratio often remains blurred due to frequent CO2 insufflations into the operating field for the anti-embolic purposes
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