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High flow rates during modified ultrafiltration decrease cerebral blood flow velocity and venous oxygen saturation in

Rosendo A Rodriguez1, Marc Ruel, Lothar Broecker

  • 1Department of Anesthesiology, Cardiac Division, Ottawa, Ontario, Canada. rrodriguez@ottawaheart.ca

The Annals of Thoracic Surgery
|June 25, 2005
PubMed
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High ultrafiltration blood flow rates reduce cerebral circulation in infants. Lower flow rates during modified ultrafiltration are safer for maintaining cerebral blood flow and oxygenation in pediatric patients.

Area of Science:

  • Pediatric Cardiology
  • Neonatal Intensive Care
  • Cerebral Hemodynamics

Background:

  • Intracranial hemodynamic effects of modified ultrafiltration in children remain uncharacterized.
  • Investigated the impact of varying blood flow rates during modified ultrafiltration on cerebral hemodynamics in pediatric patients.

Purpose of the Study:

  • To assess the effects of different blood flow rates during modified ultrafiltration on cerebral hemodynamics in children.
  • To compare hemodynamic changes in infants weighing below and above 10 kg.

Main Methods:

  • Studied 31 children undergoing cardiopulmonary bypass, categorized by weight (< or = 10 kg, n=21; >10 kg, n=10).
  • Measured middle-cerebral artery blood flow velocities and cerebral mixed venous oxygen saturations.
  • Classified patients into high (> or = 20 mL/kg/min), moderate (10-19 mL/kg/min), and low flow rate (<10 mL/kg/min) groups during ultrafiltration.

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Main Results:

  • Modified ultrafiltration increased blood pressure and hematocrit but decreased cerebral blood flow velocity and mixed venous oxygen saturation.
  • Higher ultrafiltration flow rates correlated with greater reductions in cerebral blood flow velocity and oxygen saturation.
  • Infants exposed to high flow rates exhibited more significant decreases in cerebral blood flow velocity and regional mixed venous saturation compared to moderate and low flow groups.

Conclusions:

  • High blood flow rates during modified ultrafiltration transiently impair cerebral circulation in young infants.
  • This effect may be due to increased diastolic runoff, causing a "stealing" effect from intracranial circulation.
  • Findings are particularly relevant for infants with impaired cerebral autoregulation.