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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 Luglio;81(7):752-64
Effect of perfusion pressure on the splanchnic circulation after CPB: a pilot study
Lipcsey M. 1, McNicol L. 2, Parker F. 2, Poustie S. 2, Liu G. 2, Uchino S. 3, Kattula A. 4, Bellomo R. 5 ✉
1 Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;
2 Department of Anaesthesia, Austin Hospital, Heidelberg, Melbourne, Australia;
3 Department of Intensive Care, Jikei University, Tokyo, Japan;
4 Leader Clinical Practice Improvement, Alfred Health, Prahran, Melbourne, Australia;
5 Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Australia
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.
CONCLUSION: Achieving a MAP target of 85 mmHg by means of norepinephrine infusion after CPB appears safe for the splanchnic circulation.