Towards goal-directed perfusion - Part II: Temperature dependence of Q10, oxygen-demand dependence on age and weight, further clinical insights.
Background: Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) seeks to match oxygen delivery with patient-specific metabolic demand, yet determinants of oxygen demand and dynamics of oxygen extraction ratio (OER) are not well characterised in paediatric populations. Building on our G...
| Publicado en: | Perfusion Vol. 41; no. 6; pp. 947 - 957 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications, Ltd.
Sep2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196292579&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196292579 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02676591 31J jtl: Perfusion issn: 02676591 maglogo: N pubinfo: dt: Sep2026 vid: 41 iid: 6 pid: 33180 pub: Sage Publications, Ltd. place: <Blank> artinfo: ui: 196292579 196292579 196292579 10.1177/02676591251385838 196292579 ppf: 947 ppct: 10 formats: tig: atl: Towards goal-directed perfusion - Part II: Temperature dependence of Q10, oxygen-demand dependence on age and weight, further clinical insights. aug: au: Sharabiani, Mansour T. A. Mahani, Alireza S. Issitt, Richard W. Srinivasan, Yadav Bottle, Alex Stoica, Serban affil: School of Public Health, Imperial College, London, UK sug: subj: Cardiopulmonary Bypass In Infancy and Childhood Intraoperative Care Oxygen Therapy Methods Human United Kingdom Funding Source Infant Child, Preschool Child Oxygen Consumption Age Factors Body Weight Body Temperature Oxygen Saturation Hemoglobins Oxygenation Basal Metabolic Rate Descriptive Statistics Confidence Intervals Infant: 1-23 months Child, Preschool: 2-5 years Child: 6-12 years ab: Background: Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) seeks to match oxygen delivery with patient-specific metabolic demand, yet determinants of oxygen demand and dynamics of oxygen extraction ratio (OER) are not well characterised in paediatric populations. Building on our GARIX (Global AutoRegressive Integrated model with eXogenous variables and an equilibrium force) model from Part 1, we analysed minute-level intraoperative data to derive clinical insights. Methods: GARIX integrates autoregressive memory, exogenous clinical variables (cardiac index, haemoglobin, arterial oxygen saturation, temperature), and an equilibrium component defining indexed oxygen demand (tVO2i) as a function of age, weight, and temperature. We applied GARIX to 20,443 minutes of data from 293 paediatric CPB procedures to study: (1) age- and weight-related variation in oxygen demand; (2) temperature dependence of demand, estimating local and interval Q10; (3) age-stratified OER responses to haemoglobin and other variables; and (4) time evolution of the mismatch between oxygen consumption and demand after step changes in oxygen delivery. Results: tVO2i followed a non-monotonic pattern, rising from birth to ∼3 years and declining thereafter. Metabolic demand decreased nonlinearly with temperature, with a 17% reduction from 37°C to 32°C and 39% further reduction to 27°C. Local Q10 ranged from ∼1.3 near normothermia to ∼3.8 in deep hypothermia. OER responsiveness to haemoglobin was blunted in neonates and infants compared with older children. Simulations revealed transient over- and under-oxygenation following step changes in oxygen delivery due to lags in OER adaptation. Conclusions: We identify risks of over- and under-oxygenation during CPB despite normal OER readings, challenge the use of fixed targets and constant Q10, and highlight age- and weight-dependent dynamics. These findings support individualised, time-aware perfusion strategies and lay the groundwork for model-guided decision support and control. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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