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首页> 外文期刊>Artificial Organs >Continuous Metabolic Monitoring in Infant Cardiac Surgery: Toward an Individualized Cardiopulmonary Bypass Strategy
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Continuous Metabolic Monitoring in Infant Cardiac Surgery: Toward an Individualized Cardiopulmonary Bypass Strategy

机译：婴儿心脏手术中的连续代谢监测：迈向个性化的心肺旁路策略

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Cardiopulmonary bypass (CPB) in infants is associated with morbidity due to systemic inflammatory response syndrome (SIRS). Strategies to mitigate SIRS include management of perfusion temperature, hemodilution, circuit miniaturization, and biocompatibility. Traditionally, perfusion parameters have been based on body weight. However, intraoperative monitoring of systemic and cerebral metabolic parameters suggest that often, nominal CPB flows may be overestimated. The aim of the study was to assess the safety and efficacy of continuous metabolic monitoring to manage CPB in infants during open-heart repair. Between December 2013 and October 2014, 31 consecutive neonates, infants, and young children undergoing surgery using normothermic CPB were enrolled. There were 18 male and 13 female infants, aged 1.4 +/- 1.7 years, with a mean body weight of 7.8 +/- 3.8 kg and body surface area of 0.39 m(2). The study was divided into two phases: (i) safety assessment; the first 20 patients were managed according to conventional CPB flows (150 mL/min/kg), except for a 20-min test during which CPB was adjusted to the minimum flow to maintain MVO2 > 70% and rSO(2) > 45%(group A); (ii) efficacy assessment; the following 11 patients were exclusively managed adjusting flows to maintain MVO2 > 70% and rSO2 > 45% for the entire duration of CPB (group B). Hemodynamic, metabolic, and clinical variables were compared within and between patient groups. Demographic variables were comparable in the two groups. In group A, the 20-min test allowed reduction of CPB flows greater than 10%, with no impact on pH, blood gas exchange, and lactate. In group B, metabolic monitoring resulted in no significant variation of endpoint parameters, when compared with group A patients (standard CPB), except for a 10% reduction of nominal flows. There was no mortality and no neurologic morbidity in either group. Morbidity was comparable in the two groups, including: inotropic and/or mechanical circulatory support (8 vs. 1, group A vs. B, P = 0.07), reexploration for bleeding (1 vs. none, P = not significant [NS]), renal failure requiring dialysis (none vs. 1, P = NS), prolonged ventilation (9 vs. 4, P = NS), and sepsis (2 vs. 1, P = NS). The present study shows that normothermic CPB in neonates, infants, and young children can be safely managed exclusively by systemic and cerebral metabolic monitoring. This strategy allows reduction of at least 10% of predicted CPB flows under normothermia and may lay the ground for further tailoring of CPB parameters to individual patient needs.
机译：婴儿的体外循环（CPB）与全身性炎症反应综合征（SIRS）的发病率相关。缓解SIRS的策略包括灌注温度，血液稀释，电路小型化和生物相容性的管理。传统上，灌注参数是基于体重的。然而，术中对全身和大脑代谢参数的监测表明，通常标称CPB流量可能被高估了。这项研究的目的是评估在心脏直视修复期间进行连续代谢监测以管理婴儿CPB的安全性和有效性。在2013年12月至2014年10月之间，共纳入31例使用常温CPB进行手术的新生儿，婴儿和幼儿。有18名男婴和13名女婴，年龄为1.4 +/- 1.7岁，平均体重为7.8 +/- 3.8千克，体表面积为0.39 m（2）。该研究分为两个阶段：（i）安全评估;前20名患者按照常规CPB流量（150 mL / min / kg）进行管理，除了20分钟的测试期间，将CPB调整为最小流量以维持MVO2> 70％和rSO（2）> 45％ （A组）; （ii）功效评估;接下来的11名患者在CPB的整个治疗过程中仅通过调节流量来维持MVO2> 70％和rSO2> 45％（B组）。比较患者组内和患者组之间的血流动力学，代谢和临床变量。两组的人口统计学变量具有可比性。在A组中，20分钟的测试使CPB流量减少了10％以上，而对pH值，血气交换和乳酸没有影响。与A组患者（标准CPB）相比，B组中的代谢监测没有导致终点参数的显着变化，只是名义流量减少了10％。两组均无死亡率，无神经系统疾病。两组的发病率相当，包括：正性肌力和/或机械循环支持（8 vs. 1，A vs. B组，P = 0.07），再次探查出血（1 vs.无，P =不显着[NS] ），需要透析的肾衰竭（无vs. 1，P = NS），长时间通气（9 vs. 4，P = NS）和败血症（2 vs. 1，P = NS）。本研究表明，仅通过全身和脑代谢监测就可以安全地控制新生儿，婴儿和幼儿中的常温CPB。该策略允许在常温下减少至少10％的预测CPB流量，并可以为进一步调整CPB参数以满足个别患者需求奠定基础。

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