A study by Kiziltan et al., in which 52 patients were randomized to alpha-stat versus pH stat management, showed thatpH stat management led to increased jugular venous oxygen concentrations, implying increased CBF. A study by Sakamoto et al., comparing pH stat to alpha stat during repair of cyanotic neonatal congenital heart disease, demonstrated that pH stat management led to less pulmonary collateral circulation as well as higher oxyhemoglobin and lower deoxyhemoglobin levels on cerebral near-infrared spectroscopy, suggesting greater cerebral oxygenation through improved oxygen delivery with pH stat. A prior study by Murkin et al. comparing pH stat to alpha stat showed thatduring pH stat, CBF and CMRO2 become uncoupled(CBF is pressure-dependent), whereasduring alpha-stat CBF is related to metabolic needs (CMRO2) andnotto cerebral perfusion pressure.The major concern with pH stat is the potential for increasing the cerebral embolic load.
Background: Greater cerebral metabolic suppression may increase the brain's tolerance to ischemia. Previous studies examining the magnitude of metabolic suppression afforded by profound hypothermia suggest that the greater arterial carbon dioxide tension of pH-stat management may increase metabolic suppression when compared with alpha-stat management.
Methods: New Zealand White rabbits, anesthetized with fentanyl and diazepam, were maintained during cardiopulmonary bypass (CPB) at a brain temperature of 17 degrees C with alpha-stat (group A, n = 9) or pH-stat (group B, n = 9) management. Measurements of brain temperature, systemic hemodynamics, arterial and cerebral venous blood gases and oxygen content, cerebral blood flow (CBF) (radiolabeled microspheres), and cerebral metabolic rate for oxygen (CMRO2) (Fick) were made in each animal at 65 and 95 min of CPB. To control for arterial pressure and CBF differences between techniques, additional rabbits underwent CPB at 17 degrees C. In group C (alpha-stat, n = 8), arterial pressure was decreased with nitroglycerin to values observed with pH-stat management. In group D (pH-stat, n = 8), arterial pressure was increased with angiotensin II to values observed with alpha-stat management. In groups C and D, CBF and CMRO2 were determined before (65 min of CPB) and after (95 min of CPB) arterial pressure manipulation.
Conclusions: At 17 degrees C, CMRO2 with pH-stat management is 35-40% less than that with alpha-stat management and is independent of CBF or arterial pressure differences between the techniques.
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IT has been slightly more than 10 years since Murkin et al. reported that pH-stat management results in greater cerebral blood flow (CBF) during cardiopulmonary bypass (CPB) than does [Greek small letter alpha]-stat management. After this landmark study, numerous animal and clinical studies have addressed the question of which technique might be best for the brain during cardiac surgery. It appears we may now have the answer-it depends. In children undergoing deep hypothermic circulatory arrest (DHCA), pH-stat should be used. In adults undergoing routine cardiac surgery, [Greek small letter alpha]-stat should be used. Why the difference
Layout table for study information Study Type : Observational EstimatedEnrollment : 200 participants Observational Model: Case-Control Time Perspective: Prospective Official Title: Cerebrovascular Effects of the Use of Alpha-stat or pH-stat Management of Cardiopulmonary Bypass Actual Study Start Date : February 1, 2019 Estimated Primary Completion Date : July 2020 Estimated Study Completion Date : July 2020 Groups and Cohorts Go to Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Group/Cohort Intervention/treatment Group T2DM-alphaPatients with diabetes mellitus undergoing CPB with alpha-stat acid-base management Procedure: Elective cardiopulmonary bypass (CPB)All groups undergo elective cardiopulmonary bypass (CPB) Procedure: Alpha-stat acid-base managementAcid-base status during CPB will be maintained using the alpha-stat regime Group T2DM-pHPatients with diabetes mellitus undergoing CPB with pH-stat acid-base management Procedure: Elective cardiopulmonary bypass (CPB)All groups undergo elective cardiopulmonary bypass (CPB) Procedure: pH-stat acid-base managementAcid-base status during CPB will be maintained using the pH-stat regime Group Ctrl-alphaControl patients undergoing CPB with alpha-stat acid-base management Procedure: Elective cardiopulmonary bypass (CPB)All groups undergo elective cardiopulmonary bypass (CPB) Procedure: Alpha-stat acid-base managementAcid-base status during CPB will be maintained using the alpha-stat regime Group Ctrl-pHControl patients undergoing CPB with pH-stat acid-base management Procedure: Elective cardiopulmonary bypass (CPB)All groups undergo elective cardiopulmonary bypass (CPB) Procedure: pH-stat acid-base managementAcid-base status during CPB will be maintained using the pH-stat regime Outcome Measures Go to Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Primary Outcome Measures : Cerebral tissue oxygen saturation [ Time Frame: Intraoperative interval during cardiac surgery starting from anaesthesia induction until end of the surgery. (approx. 180 minutes, measurements at 0-40-140-160 minutes). ]The spatially resolved continuous-wave NIRS technique is applied to estimate cerebral tissue oxygen saturation. This monitor uses two different wavelengths (730 and 810 nm) and has two detectors positioned 3 and 4 cm from the light source. Computing the differences between the intensity of the emitted and the reflected light with two receivers allows the measurement of the oxygen saturation of the cerebral cortex. In this study, two adult sensors are applied on the left and right sides of the patient's forehead symmetrically, and the cerebral-tissue oxygen saturation is monitored continuously during the surgical procedures and the data are registered in each protocol stage. The mean value of the rSO2 measured by the sensors is calculated for each protocol stage and used for further analyses. Central venous oxygen saturation [ Time Frame: Intraoperative interval during cardiac surgery starting from anaesthesia induction until end of the surgery. (approx. 180 minutes, measurements at 0-40-140-160 minutes). ]The central venous oxygen saturation is measured from central venous blood samples (Radiometer ABL 505, Copenhagen, Denmark). The proper positioning of the central venous catheter is verified by the surgeon via manually palpating the catheter tip. Eligibility CriteriaGo to Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Layout table for eligibility information Ages Eligible for Study: 18 Years to 80 Years (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Sampling Method: Probability Sample Study Population The patients enrolled at the Second Department of Internal Medicine and Cardiology Centre Cardiac Surgical Unit, University of Szeged Criteria Inclusion Criteria:
Courses are taught by a faculty of experts in the mathematics of uncertainty and in statistical modeling and data analysis. Industry practitioners also contribute to instruction and training through workshops and seminars. Students benefit from a dynamic learning environment featuring internships, projects and case study assignments