Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery
Background Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2022-08-01
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| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-22097.pdf |
| _version_ | 1811221939864207360 |
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| author | Ah-Reum Cho Hyeon-Jeong Lee Jeong-Min Hong Christine Kang Hyae-Jin Kim Eun-Jung Kim Min Su Kim Soeun Jeon Hyewon Hwang |
| author_facet | Ah-Reum Cho Hyeon-Jeong Lee Jeong-Min Hong Christine Kang Hyae-Jin Kim Eun-Jung Kim Min Su Kim Soeun Jeon Hyewon Hwang |
| author_sort | Ah-Reum Cho |
| collection | DOAJ |
| description | Background Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. Methods This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. Results Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. Conclusions Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery. |
| first_indexed | 2024-04-12T08:08:36Z |
| format | Article |
| id | doaj.art-1fd68ae113534b3ea1ee37b4122f79ce |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-04-12T08:08:36Z |
| publishDate | 2022-08-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-1fd68ae113534b3ea1ee37b4122f79ce2022-12-22T03:41:03ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632022-08-0175433834910.4097/kja.220978811Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgeryAh-Reum Cho0Hyeon-Jeong Lee1Jeong-Min Hong2Christine Kang3Hyae-Jin Kim4Eun-Jung Kim5Min Su Kim6Soeun Jeon7Hyewon Hwang8 Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, KoreaBackground Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. Methods This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. Results Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. Conclusions Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.http://ekja.org/upload/pdf/kja-22097.pdfcardiac surgical procedurescardiopulmonary bypasshemodynamicsmicrocirculationnear-infrared spectroscopypostoperative complications |
| spellingShingle | Ah-Reum Cho Hyeon-Jeong Lee Jeong-Min Hong Christine Kang Hyae-Jin Kim Eun-Jung Kim Min Su Kim Soeun Jeon Hyewon Hwang Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery Korean Journal of Anesthesiology cardiac surgical procedures cardiopulmonary bypass hemodynamics microcirculation near-infrared spectroscopy postoperative complications |
| title | Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery |
| title_full | Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery |
| title_fullStr | Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery |
| title_full_unstemmed | Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery |
| title_short | Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery |
| title_sort | microvascular reactivity as a predictor of major adverse events in patients with on pump cardiac surgery |
| topic | cardiac surgical procedures cardiopulmonary bypass hemodynamics microcirculation near-infrared spectroscopy postoperative complications |
| url | http://ekja.org/upload/pdf/kja-22097.pdf |
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