A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass.

BACKGROUND: Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery-associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels. This study aimed to determine whether the avoidance of arterial hyperoxemia decreased oxidative stress and reduced the severity of the multiorgan dysfunction in patients undergoing cardiac surgery utilizing CPB. METHODS: The study was a multicenter, open-label, parallel-group, randomized controlled study of the avoidance of arterial hyperoxemia versus usual care in patients undergoing cardiac surgery involving CPB. Primary outcome was the incidence and severity of AKI. Secondary outcomes included serum biomarkers for CSA-MOD, duration of mechanical ventilation, and length of intensive care and hospital stay. RESULTS: A total of 298 patients were randomized and analyzed at two hospitals in New Zealand and Australia. Mean PaO2 was significantly different between groups during CPB. There was no difference in the development of AKI (intervention arm 72.0% vs. usual care 66.2%; difference, -5.8% [95% CI, -16.1 to 4.7%]; P = 0.28), other markers of organ damage, or intensive care unit and hospital length of stay. CONCLUSIONS: Avoiding modest hyperoxemia during CPB failed to demonstrate any difference in AKI, markers of organ damage, or length of stay.

Temperature dependence of near-infrared spectra of whole blood.

The temperature dependence (30 to 40 degrees C) of near-infrared spectra (500 to 1100 nm) of whole human blood, including red blood cells with intact physiological function, is investigated. Previous studies have focused on hemoglobin solutions, but the operation of red blood cells is critically dependent on intact cell membranes to perform normal oxygen transport and other physiological functions. Thus measurements of whole blood are more directly related to changes that occur in vivo. In addition to the response of hemoglobin to temperature in the spectra, a temperature response from water in the plasma is also detected. The temperature response of the water absorption at 960 nm is approximately ten times smaller than the temperature response of the oxyhemoglobin component in the blood at 610 nm. However, it is the most significant temperature effect between 800 and 1000 nm. This work will aid the precision and understanding of full spectrum near-infrared measurements on blood.