title: Utility of cerebral oxymetry for assessing cerebral arteriolar carbon dioxide reactivity during cardiopulmonary bypass.
abstract: BACKGROUND
  Our study evaluated changes in cerebral arterial oxygen saturation (rSO2) during cardiopulmonary bypass (CPB) that were caused by changes in arterial carbon dioxide tension (PaCO2).
  
  
  METHODS
  A group of 126 patients undergoing routine, elective, first-time coronary artery bypass graft surgery (CABG) was entered into a prospective study using bilateral near-infrared spectroscopy (NIRS) before anesthetic induction (T1), after anesthetic induction (T2), and continuing at 5-minute intervals during moderate hypothermic (32°C) CPB. Pump flows were set at 2.5 L/min/m(2) and adjusted to maintain mean arterial pressure (MAP) within 10 mmHg of the MAP recorded at the initial fifth minute of CPB (T3). Thirty-two patients were excluded from data collection because MAP could not be stabilized within the target range of 60-90 mmHg. In the remaining 94 patients, after obtaining steady state flow, MAP, and oxygenation, a trial period of hypocarbia (mean PaCO2 of 30 mmHg) was induced by increasing oxygenator fresh gas flow rate (FGFR) to 2.5 L/min/m(2) (T4). A reciprocal period was then measured at reduced FGFR (0.75 L/min/m(2)) (T5).
  
  
  RESULTS
  After 20 minutes of a higher (2.75 L/min/m(2)) (FGFR), mean PaCO2 decreased from a baseline of 38 ± 4 mmHg to 30 ± 2 mmHg. This was associated with a parallel decrease (-10 ± 9%) in mixed cerebral oxygen saturation without alteration of mean arterial oxygen tension (PaO2), lactate, MAP, CPB flow, or other parameters implying increased cerebral oxygen extraction.
  
  
  CONCLUSIONS
  Parallel changes in PaCO2 and rSO2 occur during CPB when other variables remain constant, and are due to the effects of carbon dioxide on cerebral arterioles. Cerebral oxygen saturation measured by NIRS may be a useful indirect measure of PaCO2 when continuous blood gas analysis is not possible during open-heart surgery. Cerebral oximetry values may be useful measurements for setting an optimum gas flow rate through the oxygenator.
authors.affiliation: Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Ariturk
authors.affiliation: Department of Cardiovascular Surgery, Acıbadem Healthcare Group, Kadikoy Hospital.
authors.forename: Murat
authors.initials: M
authors.lastname: Okten
authors.affiliation: Department of Anesthesiology and Reanimation, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Zehra Serpil Ustalar
authors.initials: ZS
authors.lastname: Ozgen
authors.affiliation: Department of Anesthesiology and Reanimation, Acıbadem Healthcare Group, Kadikoy Hospital.
authors.forename: Esin
authors.initials: E
authors.lastname: Erkek
authors.affiliation: Department of Anesthesiology and Reanimation, Acıbadem Healthcare Group, Kadikoy Hospital.
authors.forename: Pinar
authors.initials: P
authors.lastname: Uysal
authors.affiliation: Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Gullu
authors.affiliation: Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Senay
authors.affiliation: Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Karabulut
authors.affiliation: Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Alhan
authors.affiliation: Department of Anesthesiology and Reanimation, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Toraman
mesh_terms: D000368:Aged; D001160:Arterioles / Q000378:metabolism; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000503:physiopathology*; D002245:Carbon Dioxide / Q000097:blood*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen