Cerebral blood flow during cardiopulmonary bypass: influence of temperature and pH management strategy.
Because disordered autoregulation of cerebral blood flow may underlie neurologic injury associated with cardiopulmonary bypass (CPB), we studied the effects of normothermic (37 degrees C) and hypothermic (18 degrees C) CPB on cerebral vascular reactivity in 6 to 8-week-old piglets. Hypothermic CPB animals were subdivided into alpha-stat and pH-stat groups (n = 6 animals each group) according to acid-base management protocol. Cerebral blood flow (CBF), cerebral oxygen consumption (CMRO2), cerebral vascular resistance (CVR), and CBF response to hypercapnia were examined before, during, and 1 hour after CPB and used to calculate CVR per millimeter of mercury change in arterial partial pressure of CO2: (CVRnormocapnia - CVRhypercapnia)/(PaCO2 hypercapnia - PaCO2 normocapnia). Before CPB, CBF, CMRO2, and vascular reactivity to elevated CO2 were similar in the three groups; these parameters remained unchanged by normothermic CPB. However, during hypothermic CPB, CBF and CMRO2 decreased in both alpha-stat and pH-stat groups; in the alpha-stat group, CBF decreased from 27 +/- 5 mL.min-1.100 g-1 (normothermic CPB) to 5 +/- 1 mL.min-1.100 g-1 (hypothermic CPB) (p < 0.05) and CMRO2 decreased from 1.8 +/- 0.21 to 0.24 +/- 0.04 mL.min-1.100 g-1 (p < 0.05), whereas in the pH-stat group CBF decreased from 28 +/- 2 to 9 +/- 1 mL.min-1. 100 g-1 (p < 0.05) and CMRO2 decreased from 1.63 +/- 0.07 to 0.31 +/- 0.09 mL.min-1.100 g-1 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Cheng
W
W
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Hartmann
J F
JF
Cameron
D E
DE
Griffiths
E M
EM
Kirsch
J R
JR
Traystman
R J
RJ
D000818:Animals; D001831:Body Temperature / Q000502:physiology*; D001921:Brain / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006863:Hydrogen-Ion Concentration; D006935:Hypercapnia / Q000503:physiopathology*; D007036:Hypothermia, Induced; D010101:Oxygen Consumption; D013552:Swine; D014655:Vascular Resistance / Q000502:physiology*