Influence of the high-flow, low-rezistance technique perfusion strategie on cerebral metabolism on pediatric open heart surgery

As a result of the cardiopulmonary bypass; emerging vasoconstriction, bleeding, the capillary leak syndrome, edema intraoperatif, many center of cardiac surgery reduce pomp flow during bypass. As a result, inadequate oxygen at tissue supply and metabolic increase of the end products (lactate), respectively.The brain can not store glucose and for its continuousness O2 and glucose shall be needed. Total brain blood flow is 45-55 ml/100 g / min. Despite of the fact that it constitutes 2 % of the body weight it creates 12-15 % of cardiac output. Brain O2 consumption is 49 ml / min, this is 20 % consumption of the whole-body. Brain uses glucose by 5,5 mgr / 100 gr / min. and this is 25 % of the total glucose consumption of the body.Pediatric open cardiac surgery in patients between high-flow, low-resistance comparing the effects studies are limited. The aim of this prospective study is to investigate the benefit of the high-flow, low-resistance technique in accordance with normal flow.40 patients, which have been applied open heart surgery due to congenital heart disease, were studied in this prospective study. Patients are divided into two groups.Patient applied normal flow (group 1: 2,4 l/m2/BSA) Patients applied the high-flow, low-resistance (group 2: 2,8 l/m2/BSA). The following parameters have been examined; theese are respectively, after anaesthetic induction, before skin incision (phase I), 20 min. of the aortic cross clamp (phase II), 40 min. (phase III), 60 min. (phase III) and after 10 min. of stopping cardiopulmonary bypass (phase IV) and glucose, lactate, blood gas from the arterial and venous blood samples. Additionally, the following parametres have been examined as well. Theese are respectivelly, immunologic parameters Interleukin 6 (IL-6), Interleukin 8 (IL-8), procalcitonin (PCT) phase I, phase V and after 24 hours of the operation (phase VI). Statistically significant results in the group and between groups was investigated. It has been presented that there are no significant differences in terms of parameters among high-flow, low-resistance applied group II and normal flow applied group I (p<0.05)Key Words: High-flow, low-resistance technique; brain metabolism, Cardiopulmonary bypass, Pediatric open cardiac surgery