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Oxygen delivery post-cardiopulmonary bypass may not be compromised by decreases in radial­aortic pressure gradients

S. Pothula1, K. R. Ediale1, V. Kumar1, V. T. Sanchala1, M. A. Inchiosa, Jr.1,2
1Department of Anesthesiology and 2Department of Pharmacology, New York Medical College, Valhalla, New York, USA
[Applied Cardiopulmonary Pathophysiology 14: 21-28, 2010]


Common hemodynamic changes following cardiopulmonary bypass (CPB) include decreases in the radial artery-to-aortic pressure gradient (R-A), decreases in systemic vascular resistance (SVR), and increases in cardiac index (CI).  To help evaluate the clinical significance of a decreased R-A gradient, we compared oxygen delivery (DO2) pre- and post-CPB.
As a pilot study, data were collected from 20 consecutive patients undergoing routine cardiac surgery.  Radial and aortic pressures (R-A gradient), DO2, CI, and SVR were determined five minutes before and after CPB.
Average systolic R-A gradients changed from positive pre-CPB (+13.85 mmHg) to negative post-CPB (-3.85) (p< 0.001).  Mean pressure gradients showed the same reversal (p < 0.001).  CI increased pre- to post-CPB, 2.14 liters min-1 m-2 to 3.02; p< 0.001.  SVR decreased, 1342 dynes-sec-cm-5 to 827; p< 0.001. Average DO2 was unchanged (604.4 and 669.8 ml min-1). 
However, a subgroup of patients showed marked increases in DO2 despite decreases in R-A gradients.

Key words: cardiac index, oxygen delivery, radial-aortic pressure gradients, systemic vascular resistance, vasoplegic syndrome

Address for corresponding: 
Mario A. Inchiosa, Jr., Ph.D., Department of Pharmacology, New York Medical College, Valhalla, New York 10595, USA
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