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Published on: September 22, 2017
Temperature-adjusted perfusion-metabolic phenotyping during cardiopulmonary bypass: An exploratory study
Enrico Squiccimarro1,2, Sara Catalano1, Chiara Colombaro1
1Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Perfusion
|August 14, 2026
Summary
Identifying distinct patient phenotypes during cardiopulmonary bypass (CPB) using temperature-adjusted metabolic data reveals a high-extraction/high-metabolic-stress group with increased risk of acute kidney injury (AKI). This highlights the need for a broader goal-directed perfusion framework beyond indexed oxygen delivery alone.
Area of Science:
- Cardiovascular Surgery
- Physiology
- Nephrology
Background:
- Traditional goal-directed perfusion (GDP) in cardiopulmonary bypass (CPB) focuses on indexed oxygen delivery (DO2i).
- Metabolic responses during aortic cross-clamping involve complex interactions of oxygen delivery, extraction (O2ER), and temperature-dependent demand.
- Existing perfusion strategies may not fully capture the metabolic state during CPB.
Purpose of the Study:
- To identify temperature-adjusted perfusion-metabolic phenotypes during CPB aortic cross-clamping.
- To investigate the association of these phenotypes with early postoperative outcomes, particularly acute kidney injury (AKI).
- To evaluate the utility of a comprehensive GDP framework beyond DO2i.
Main Methods:
- Retrospective analysis of perfusion and clinical data from 70 patients undergoing CPB.
- Normalization and resampling of perfusion variables (DO2i, O2ER) and temperature-adjusted metabolic markers (VO2i_37eq, VCO2i_37eq).
- Application of principal component analysis and k-means clustering to define phenotypes, followed by logistic regression for outcome association (AKI).
Main Results:
- Three distinct phenotypes were identified: low-extraction/low-demand, high-delivery/compensated-demand, and high-extraction/high-stress.
- The high-extraction/high-metabolic-stress phenotype exhibited the highest incidence of AKI (53.1%) and more severe AKI stages (18.8%).
- This high-stress phenotype was also linked to increased postoperative creatinine levels and longer ICU stays, remaining associated with AKI in multivariable analysis.
Conclusions:
- Temperature-adjusted analysis of perfusion trajectories effectively identifies distinct patient phenotypes during CPB.
- A high-extraction/high-metabolic-stress phenotype is associated with adverse early renal outcomes.
- These findings support an expanded GDP strategy that incorporates metabolic status beyond DO2i alone for improved patient management.
