Alarcon, Mikko Anthony P. BSN408/Group 32 Evidenced Based Nursing I.

Clinical Question Cerebral oxygenation; it is effective determinants during cardiac surgery? II. Citation NollertG.et.al(2008).Determinants of cerebral oxygenation during cardiac surg ery, AHA Journal,Vol. 92 (9 Suppl), pp.27-33. III. Study Characteristics A. Patient included: Forty-one consecutive patients were investigated during cardiac surgery while on CPB. Operative management included moderate hypothermia of 26C and the alpha-stat pH management. B .Interventions Compared: Compared the rates with near-infrared spectrophotometry, changes in oxygenated hemoglobin (HbO2, representing oxygen delivery) and oxidized cytochrome a,a3 (CtO2, cellular oxygenation) in brain tissue were obtained noninvasively, compare to the venous saturation of the brain was measured via a catheter in the jugular bulb (SBJO2). The influence of operative management parameters on cerebral oxygenation was calculated by univariate and multiple regression analyses. C. Outcome monitored: In show that the outcome before and after CPB there was no significant multivariate determinant of cerebral oxygenation. During CPB, HbO2 depended solely on PCO2 (P<.01; r=.89). CtO2 was determined by pH (P<.01), esophageal temperature (P<.01), PCO2 (P<.01), and Hb (P<.01). These parameters explained nearly all changes of the cytochrome measurements during CPB (r=.99). Arterial PCO2 (P<.01) and pH (P<.01) influenced brain venous oxygen saturation (SBJO2; r=.98). D. Does the study focus on a significant problem in clinical setting? a. Yes, because the study focuses on a significant problem in a clinical practice because it can help to determined if the determinants of Cerebral Oxygenation during Cardiac Surgery Methodology a. Methodology used: descriptive b. Design: qualitative

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c. Setting: Ludwig-Maximilians-University in Munich, Germany d. Data Sources: Shaw PJ, Bates D, Cartlidge NEF, French JF, Heaviside D, Julian DG, Shaw DA. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass surgery and peripheral vascular surgery. Stroke. 1987;18:700-707. e. Subject selection 1. Inclusion criteria The researchers include and studied forty-one consecutive patients were investigated during cardiac surgery while on CPB. 2. Exclusive criteria The researchers exclude the patients were investigated before and after cardiac surgery while on CPB. f. Has the study been replicated? No, the researchers were the first one to study the determinants of Cerebral Oxygenation during Cardiac Surgery. But there are already many studies about cardiac surgery. g. What were the risks and benefits of the nursing action / intervention tested in the study? The risk of the nursing action is adjusted the estimates of the effect of having cerebral oxygenation during cardiac surgery, but we were unable to directly assess the effect of timing of onset or clinical severity because data were not available. The benefits would be to give information to the public the determinants of Cerebral Oxygenation during Cardiac Surgery. V. Result of the study The results of the study notified that one patient died on the second postoperative day because of myocardial infarction due to early graft closure. No patient suffered from central neurological deficits postoperatively; one patient had a transient peripheral paresis of the left arm due to operative placement. Four patients showed transient neuropsychological deficits postoperatively diagnosed by a score 23 in the Mini-Mental State test obtained from the first through the third postoperative day. These patients had a lower minimum CtO2 compared with those without these deficits (-4.5 versus -0.7 mol/L; P<.05). All other measured parameters showed no significant differences between the groups. Authors Conclusion/Recommendations The Authors conclude that cerebral oxygenation is autoregulated during cardiac surgery before and after CPB. During CPB, Hb, temperature, pH, and PCO2 determine at least 85% of all changes in cerebral oxygenation. The

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main causes of impaired cerebral oxygenation are the decrease in Hb with hemodilution, vasoconstriction due to hypocapnia, and the leftward shift of the Hb binding curve in alkalosis and hypothermia.

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Applicability Does the study provide a direct enough answer to your clinical question in terms of type of patients, interventions and outcome? The study did provide a direct answer to the clinical question in terms of types of patients, interventions, and outcome. It saw also stated that the main causes of impaired cerebral oxygenation are the decrease in Hb with hemodilution, vasoconstriction due to hypocapnia, and the leftward shift of the Hb binding curve in alkalosis and hypothermia. Is it feasible to carry out the nursing action in the real world? The study is not feasible to carry out the nursing action in real world because the variable for this study is insufficient, the efficacy and outcomes of screening remain unknown and the population, setting and Intervention are too broad to carry out the nursing action but It is applicable for the nurses to educate the person who have cardiac surgery about the determinants of Cerebral Oxygenation.

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Reviewers Conclusion/Commentary Studying health is very essential to us. Having more people doing this research benefited not only those with diseases or illnesses but also a healthy individual especially health care provider by learning. In this article, the study demonstrates an important issue that arises with large population-based studies. The presence of a statistically significant association does not prove causation. Such studies potentially have many confounding factors that can cause weak, but statistically significant, associations, as seen here. Overall that study help us to determined the determinants of Cerebral Oxygenation during cardiac surgery.