Correlation between regional tissue perfusion saturation and lactate level during cardiopulmonary bypass

• Published in: Korean journal of anesthesiology Vol. 71; no. 5; pp. 361 - 367
• Main Authors: Lee, Yoon-Sook, Kim, Woon Young, Yoo, Ji Won, Jung, Hyun Don, Min, Too Jae
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Anesthesiologists 01-10-2018; 대한마취통증의학회
• Subjects: cardiopulmonary bypass; Clinical; hypoperfusion; serum lactate level; tissue oxygen saturation; 마취과학; Cardiopulmonary bypass; Hypoperfusion; Serum lactate level; Tissue oxygen saturation
• ISSN: 2005-6419; 2005-7563
• DOI: 10.4097/kja.d.17.00002

Cardiopulmonary bypass (CPB) can cause systemic hypoperfusion, which remains undetected by routine monitoring of physiological parameters. Noninvasive tissue perfusion monitoring offers a clinical benefit by detecting low systemic perfusion. In this study, we tried to evaluate whether regional tissue perfusion saturation reflects systemic hypoperfusion during CPB.
This retrospective study included 29 patients with American Society of Anesthesiologists physical status II-III, who required cardiac surgery with CPB. We evaluated the correlations of serum lactate and delivery oxygen with organ perfusion values of peripheral tissue oxygen saturation and cerebral oxygen saturation. Data were recorded at different stages of CPB: T1 (pre-CPB), T2 (cooling), T3 (hypothermia), T4 (rewarming), and T5 (post-CPB).
Lactate levels were elevated after CPB and up to weaning (P < 0.05). The levels of peripheral and tissue oxygen saturation decreased after the start of CPB (P < 0.05). Lactate levels were negatively correlated with peripheral tissue oxygen saturation levels at T4 (R = -0.384) and T5 (R = -0.370) and positively correlated with cerebral oxygen saturation at T3 (R = 0.445). Additionally, delivery oxygen was positively correlated with peripheral tissue oxygen saturation at T4 (R = 0.466).
In this study, we demonstrated that peripheral tissue oxygen saturation can be a reliable tool for monitoring systemic hypoperfusion during CPB period. We also believe that peripheral tissue oxygen saturation is a valuable marker for detecting early stages of hypoperfusion during cardiac surgery.