Cerebral pressure-flow velocity relationship during hypothermic cardiopulmonary bypass in neonates and infants

To examine the effect of temperature on the relationship between cerebral perfusion pressure (CPP) and cerebral blood flow velocity (CBFV) and the effect of low-flow cardiopulmonary bypass (CPB) on cerebral perfusion, we studied 25 neonates and infants ranging from 3 to 210 days of age at three nasopharyngeal temperature (NPT) ranges during cardiopulmonary bypass. Pressure-flow velocity relationships were studied during normothermic (NPT = 36-37 degrees C), moderate hypothermic (NPT = 23-25 degrees C), and profound hypothermic (NPT = 14-20 degrees C) CPB. A transcranial Doppler monitor was used to obtain CBFV, which was measured in the M1 segment of the middle cerebral artery. The CBFV was used as an index of cerebral perfusion. Anterior fontanel pressure (AFP) was subtracted from mean arterial pressure (MAP) to calculate CPP in mm Hg. Nasopharyngeal temperature, PaCO2, and hematocrit were controlled during the study period. Arterial blood gases were analyzed at 37 degrees C, uncorrected for body temperature (alpha-stat acid-base management). The CBFV measurements were made over a range of CPP from 6 to 90 mm Hg. Using nonlinear regression analysis, we showed that cerebral pressure-flow velocity autoregulation was present during normothermic CPB (r2 = 0.68). Autoregulation became pressure-passive, using linear regression analysis, during moderate hypothermic CPB (r2 = 0.33) and profound hypothermic CPB (r2 = 0.69). Cerebral blood-flow velocity was not detectable at a mean (+/- SD) CPP of 9 (+/- 2) mm Hg induced by the low-flow CBP state but became apparent when CPP was increased to 13 (+/- 1) mm Hg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)