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Abstract

COMBINED CENTRAL VENOUS OXYGEN SATURATION AND LACTATE AS MARKERS OF OCCULT HYPOPERFUSION AND OUTCOME FOLLOWING CARDIAC SURGERY

Santosh Devi(MD), Sheikh Irshad Ahmad (Associate Professor), Abdul Waheed Mir (Assistant Professor), Showkat Gurcoo (Professor), Tantry Tariq Gani(MD)* and Tanveera Gani

ABSTRACT

Background: Routinely monitored parameters may not reliably detect perfusion abnormalities. However, ScvO2 & lactate levels can detect occult hypoperfusion and identify patients at risk for complications. Objective: This study was aimed to examine the occurrence of postoperative occult hypoperfusion, determined by the combination of low ScvO2 & elevated lactate & its effect on outcomes after cardiac surgery. Study design: Prospective observational study. Setting: Tertiary care hospital. Patient population: Patients undergoing different cardiac surgeries under cardiopulmonary bypass. Results: The study included 100 patients. Postoperative ScvO2 & arterial lactate were obtained on arrival to the ICU & at 24 hours after ICU admission. Mod erate GTH was defined as ScvO2 <70% and lactate 2 to 4 mmol/L and severe GTH was defined as ScvO2 <70% & lactate >4 mmol/L. Occult hypoperfusion was defined as moderate to severe GTH with MAP>65 mmHg, CVP>8 mmHg & urine output >0.5mL/kg/h. 37 patients had occult hypoperfusion on arrival to Cardiac Surgical ICU. Patients with occult hypoperfusion on ICU admission had significantly longer ICU/Hospital LOS & ventilation time (p<0.001). Patients with severe GTH (n=15) had significantly longer Hospital LOS & significantly more no of complications per patient (p<0.05) as compared to those with moderate GTH (n=22). Patients who persisted with occult hypoperfusion at 24Hr (n=14) had significantly longer time on ventilator, ICU/Hospital LOS & no. of complications (p<0.05). Con-clusions: The incidence of GTH is high after cardiac surgery. Postoperative ScvO2 &lactate may be valuable measurements to identify patients with occult hypoperfusion & subsequently guide hemodynamic optimization to positively affect postoperative outcome in patients after cardiac surgery.

Keywords: Routinely monitored hypoperfusion after cardiac surgery.


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