Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Influence of chronic hypoxemia and high concentration of hemoglobinon the development of complications in the early postoperative periodin patients with cyanotic congenital heart diseases operatedwith cardiopulmonary bypass

Authors: A.P. Chislova, I.A. Yurlov

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-4-220-225

UDC: 616.12-007-053.1-089:616.12-089.8-78]-089.168.1-06

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (4): 220-225

Quote as: Chislova A.P., Yurlov I.A. Influence of chronic hypoxemia and high concentration of hemoglobin on the development of complications in the early postoperative period in patients with cyanotic congenital heart diseases operated with cardiopulmonary bypass. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (4): 220–5 (in Russ.). DOI: 10.24022/1814-6910-2017-14-4-220-225

Received / Accepted:  24.07.2017/02.08.2017

Full text:  

Abstract

Objective: to identify the impact of chronic hypoxemia or initial concentration of hemoglobin on development of organ dysfunction in patients with congenital heart diseases underwent surgery with cardiopulmonary bypass (CPB), to study their effect on the dynamics of serum lactate and the parameters of the hemostasis system in the early postoperative period.
Material and methods. The study included 93 patients undergoing cardiac surgery with CPB. There were compared two groups with a complicated and uncomplicated course of the early postoperative period. ROC analysis was used to study the effect of chronic hypoxemia and initial hemoglobin concentration on the development of early postoperative complications. There was studied the presence of a correlation between the partial pressure of arterial oxygen, hemoglobin concentration before surgery and serum lactate concentration, hemostasis.
Results. In the groups with complications and without complications, statistically significant differences were found: in terms of initial hypoxemia, levels of serum lactate and INR values at admission to the ICU. There was no difference in hemoglobin concentrations. When analyzing the dependence of the development of organ dysfunctions in the early postoperative period on the values of the partial pressure of arterial blood oxygen before surgery, it is revealed that hypoxemia may be a predictor of complications, AUC = 0.687, cut-off value 203 mmHg. When analyzing the dependence of the development of complications on the concentration of hemoglobin, the unsatisfactory quality of the model is revealed. A correlation was found between the value of the arterial blood oxygen partial pressure and the parameters of the hemostasis system. It was found a statistically significant correlation between initial concentration of hemoglobin and the maximum serum lactate concentration, as well as with parameters of the hemostasis system.
Conclusion. Chronic hypoxemia plays a leading role in the development of early postoperative complications. The initial hypoxemia is associated with coagulopathy, but not the concentration of serum lactate. A high level of hemoglobin in patients with cyanosis is associated with increased serum lactate and coagulopathy, but not with the risk of early postoperative complications.

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About Authors

  • Chislova Anna Pavlovna, Anesthesiologist-Intensivist; orcid.org/0000-0003-0928-9392
  • Yurlov Ivan Aleksandrovich, Cand. Med, Sc., Cardiac Surgeon; orcid.org/0000-0002-5812-8408

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