Optimal brain perfusion pressure derived from the continuous monitoring of cerebral autoregulation status during neonatal heart surgery under cardiopulmonary bypass in relation to brain injury: An observational study - 03/05/25
, Erta Beqiri d, Peter Smielewski d, Alexis Chenouard b, Aurélie Gaultier e, Flavie Sadones f, Ugo Gouedard c, Nicolas Joram b, Pascal Amedro a, gAbstract |
Background |
Understanding cerebral blood flow regulation and later optimizing brain perfusion is part of neuroprotection during cardiopulmonary bypass (CPB) in neonates.
Methods |
A total of 38 neonates undergoing CPB were monitored using near-infrared spectrometry and mean arterial pressure (MAP). Cerebral autoregulation (CAR) was assessed through the continuous measurement of the Cerebral Oxygenation Index (COx), and CAR-derived metrics were determined by plotting averaged COx values by MAP: Optimal MAP (MAPopt), lower limit of CAR (LLA), upper limit of CAR (ULA).
Results |
Out of 38, 17 (45%) neonates exhibited moderate to severe brain lesions post-operatively. The onset of CPB was associated with CAR disruption (mean COx pre-CPB = 0.16 ± 0.11; during CPB: 0.39 ± 0.37, p < 0.001). A LLA was identified in 31 out of 38 (82%), 23 out of 38 (61%), and 14 out of 38 (37%) patients before, during, and after CPB, respectively. An ULA was identified in 29 out of 38 (76%), 22 out of 38 (58%), and 14 out of 38 (37%) patients in the same time frames. Patients with abnormal post-operative brain MRI spent more time below the LLA during CPB: 28.3% [17.1–32.9] versus 9.9% [6.9–18.5] in patients without detected brain injury, p = 0.039. No differences were observed regarding the time spent above the upper limit of autoregulation.
Conclusion |
The study provides valuable insights into the intricate relationship between intraoperative cerebral hemodynamics and post-operative brain injury. Further research is warranted to explore potential interventions based on CAR-derived metrics during CPB in neonates.
Clinical trial registration number |
Not applicable.
Prior presentation |
Not applicable.
Le texte complet de cet article est disponible en PDF.Abbreviations : ABP, AUC, CAR, CBF, CHD, COx, CPB, LLA, MAP, MAPopt, NIRS, RSO2, SvO2, ULA
Keywords : Cerebral autoregulation, Neonatal heart surgery, Cardiopulmonary bypass, Cerebral oximetry, Mean arterial pressure, Brain injury, MRI severity scoring
Plan
Vol 44 - N° 3
Article 101509- mai 2025 Retour au numéro
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