title: Effect of perfusion pressure on the splanchnic circulation after CPB: a pilot study.
abstract: BACKGROUND
  The impact of different blood pressure targets is unknown for post cardiac surgery patient in the intensive care unit. We, therefore, investigated the effects of a mean arterial pressure (MAP) target of 65 or 85 mmHg on splanchnic oxygenation, metabolic function, cytokine regulation and gastric tonometry after cardiopulmonary bypass.
  
  
  METHODS
  Sixteen patients were randomized to the HLH group (high-low-high) where MAP of 85-65-85 mmHg was targeted or the LHL group where MAP 65-85-65 mmHg was targeted with norepinephrine infusion.
  
  
  RESULTS
  MAP targets were achieved in all patients at all timepoints (64 ± 3, 84 ± 4; 65 ± 5, LHL group; vs. 84 ± 3; 66 ± 2; 85 ± 5 mmHg, HLH group). At corresponding timepoints, hepatic venous saturation was 41 ± 15%; 58 ± 24%; 56 ± 21% in the LHL group vs. 50 ± 19%; 43 ± 20%; 41 ± 18% in the HLH group (P<0.05). No changes were observed in cardiac output, global or trans-splanchnic lactate levels and cytokine levels or in gastric tonometry CO2.
  
  
  CONCLUSIONS
  Achieving a MAP target of 85 mmHg by means of norepinephrine infusion after CPB appears safe for the splanchnic circulation.
authors.affiliation: Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden - rinaldo.bellomo@austin.org.au.
authors.forename: M
authors.initials: M
authors.lastname: Lipcsey
authors.forename: L
authors.initials: L
authors.lastname: McNicol
authors.forename: F
authors.initials: F
authors.lastname: Parker
authors.forename: S
authors.initials: S
authors.lastname: Poustie
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.forename: S
authors.initials: S
authors.lastname: Uchino
authors.forename: A
authors.initials: A
authors.lastname: Kattula
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D018592:Cross-Over Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D013152:Splanchnic Circulation / Q000187:drug effects; D013270:Stomach / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D016207:Cytokines; D014662:Vasoconstrictor Agents; D010100:Oxygen; D009638:Norepinephrine