Abstract
Near-infrared spectroscopy assessment of cytochrome oxygenation could be a valuable technique to monitor cerebral intraneuronal oxygen delivery during cardiopulmonary bypass. However, the validity of the cytochrome signal has been questioned as it could easily be overwhelmed by the Hb signal. Five- to six-week-old control piglets (n = 5) underwent cardiopulmonary bypass at 37°C. Study animals (n = 10) received 100 mg/kg of sodium cyanide to uncouple cytochrome from Hb. Hematocrit was then decreased in steps of 5% from 35 to 5% with crystalloid hemodilution. In study piglets, the initiation of cardiopulmonary bypass was associated with oxygenated Hb increasing from 0 to 62.9 ± 25.6 μM times the differential path-length factor, and oxidized cytochrome a,a3 increasing to 1.9 ± 1.8 μM times the differential path-length factor. Cyanide caused oxygenated Hb to increase further to 132.3 ± 48.9 μM times the differential path-length factor, and oxidized cytochrome c decreased to −7.0 ± 2.6 μM times the differential path-length factor as anticipated, confirming uncoupling of electron transport. However, hemodilution subsequently resulted in linear decreases in oxidized cytochrome a,a3 (F = 8.57, p < 0.001) suggesting important cross-talk between the Hb and cytochrome signals as cytochrome is only intracellular. In control piglets, tissue oxygenation index showed a positive correlation with pump flow (r = 0.986, p = 0.013). The cytochrome signal as presently measured by near-infrared spectroscopy is highly dependent on hematocrit.
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Abbreviations
- CPB:
-
cardiopulmonary bypass
- CytO2:
-
oxidized cytochrome a,a3
- DPF:
-
differential path-length factor
- HbO2:
-
oxygenated Hb
- HbT:
-
total Hb
- HHb:
-
deoxygenated Hb
- NIRS:
-
near-infrared spectroscopy
- TOI:
-
tissue oxygenation index
- CCD:
-
charge-coupled device
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Acknowledgements
The authors thank Cheryl Carney and Jason Balara for their technical assistance. David Zurakowski, Ph.D., from the Department of Biostatistics at Children's Hospital, Boston, provided us with valuable advice regarding the statistical analysis. We also thank Hamamatsu Photonics, K.K. for their support.
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Supported by National Institutes of Health grant 5R01HL600922 (R.A.J).
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Sakamoto, T., Jonas, R., Stock, U. et al. Utility and Limitations of Near-Infrared Spectroscopy during Cardiopulmonary Bypass in a Piglet Model. Pediatr Res 49, 770–776 (2001). https://doi.org/10.1203/00006450-200106000-00010
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DOI: https://doi.org/10.1203/00006450-200106000-00010
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