TY - JOUR
T1 - Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass
AU - Croughwell, Narda D.
AU - Newman, Mark F.
AU - Blumenthal, James A.
AU - White, William D.
AU - Lewis, Julia B.
AU - Frasco, Peter E.
AU - Smith, Lloyd R.
AU - Thyrum, Elizabeth A.
AU - Hurwitz, Barrie J.
AU - Leone, Bruce J.
AU - Schell, Randall M.
AU - Reves, Joseph G.
N1 - Funding Information:
This research was supported in part by grant R01-AG09663 from the National Institutes of Health.
PY - 1994/12
Y1 - 1994/12
N2 - Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly (p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption (r = -0.6; p < 0.0005), cerebr al blood flow (t = 0.4; p < 0.0,105), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial pressure (r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood flow to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.
AB - Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly (p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption (r = -0.6; p < 0.0005), cerebr al blood flow (t = 0.4; p < 0.0,105), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial pressure (r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood flow to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.
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U2 - 10.1016/0003-4975(94)91666-7
DO - 10.1016/0003-4975(94)91666-7
M3 - Article
C2 - 7979740
AN - SCOPUS:0028135310
SN - 0003-4975
VL - 58
SP - 1702
EP - 1708
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -