Entradas publicadas en Swipe visitors

A set of the cardiac index data during extracorporeal circulation (ECC) for patients with mixed venous oxygen saturation (SvO_dos) above 68%, mean arterial pressure (MAP) above 60 mmHg and tissue oxygen delivery (DO₂) greater than 280 mL/min/m 2 , in the function of haemoglobin density and tissue oxygen delivery

The linear regression curves for three selected oxygen delivery (DO₂) levels showing the relationship between cardiac index (CI) and haemoglobin density

Dialogue

Recently accumulating evidence has suggested that the trends in current perfusion practice need to be improved as we experience tremendous technological improvement every day. The discussed new GDP concept provides an ideal opportunity to apply treatment which is tailored to the individual patient’s needs and, therefore, aims to diminish the risk of complications throughout the entire surgical procedure. Consequently, the emerging concept jeopardizes the current widely accepted CPB strategies of organ perfusion based on a constant pump flow rate and the ubiquitous indicators of tissue perfusion, such as lactate concentration and urine output, with lactates representing effective tissue perfusion and metabolism balance, and urine output being a vital indicator of renal perfusion. The main goal of GDP is to optimize tissue oxygen delivery and extraction. Interestingly, adequate perfusion represented by the flow rate is a crucial component of DO₂.

In current clinical practice, the haemodynamic values used by perfusionists are based solely on observational studies designed on the basis of the physiology of a healthy individual. For instance, the pump flow rate is the equivalent of the average calculated cardiac index (CI). The advancement in System M in-line non-invasive monitoring provides an opportunity to conduct real-time observation of flow rates, both venous and arterial saturation, haemoglobin level, the extent of carbon dioxide production and also calculate all exponents of oxygen transport.