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bsn 137 – group 148 -B
“Cerebral oxygenation; it is effective
determinants during cardiac surgery? ”
Members:
Alpe, Aldrin Ian Villaseñor, Marijoe A.
Submitted To:
I. Clinical Question
II. Citation
Patient included:
Forty-one consecutive patients were investigated during cardiac surgery
while on CPB. Operative management included moderate hypothermia of
26°C and the alpha-stat pH management.
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.
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).
b. Design: qualitative
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
g. What were the risks and benefits of the nursing action / intervention
tested in 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 µmol/L; P<.05). All other measured parameters showed no significant
differences between the groups.
VII. Applicability
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.
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.