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Alarcon, Mikko Anthony P.

BSN408/Group 32

Evidenced Based Nursing

I. Clinical Question

Cerebral oxygenation; it is effective determinants during cardiac surgery?

II. Citation

NollertG.et.al(2008).Determinants of cerebral oxygenation during cardiac surgery, AHA Journal,Vol. 92 (9 Suppl), pp.27-33.

III. Study Characteristics

A. Patient included:Forty-one consecutive patients were investigated during

cardiac surgery

while on CPB. Operative management included moderate hypothermia of26°C and the alpha-stat pH management.

B .Interventions Compared:Compared the rates with near-infrared spectrophotometry, changes inoxygenated hemoglobin

(HbO2, representing oxygen delivery) and

oxidized cytochrome a,a3 (CtO2, cellular oxygenation) in brain tissue were

obtained noninvasively, compare to the venous saturation of the brain was

measured via

a catheter in the jugular bulb (SBJO2). The influence ofoperative management

parameters on cerebral oxygenation wascalculated by univariate and multiple regression analyses.

C. Outcome monitored:In show that the outcome before and after CPB there was no significantmultivariate determinant of cerebral oxygenation. During CPB, HbO2 depended solely on PCO2 (P <.01; r =.89). CtO2 was determined by pH(P <.01), esophageal temperature (P <.01), PCO2 (P <.01), and Hb (P <.01).

These parameters explained nearly all changes of the cytochrome

measurements during CPB (r =.99). Arterial PCO2 (P <.01) and pH (P <.01)influenced brain venous oxygen saturation (SBJO2;

r =.98).

D. Does the study focus on a significant problem in clinical setting? a. Yes, because the study focuses on a significant problem in a clinicalpractice because it can help to determined if the determinants of CerebralOxygenation during Cardiac Surgery

IV. Methodology

Methodology used: descriptive

b Design: qualitative



c Setting: Ludwig-Maximilians-University in Munich, Germany

d Data Sources: Shaw PJ, Bates D, Cartlidge NEF, French JF, Heaviside D, Julian DG,Shaw DA. Neurologic and neuropsychological morbidity following majorsurgery: comparison of coronary artery bypass surgery and peripheral

vascular surgery. Stroke. 1987;18:700-707.

e Subject selection1. Inclusion criteria

The researchers include and studied forty-one consecutivepatients were investigated during

cardiac surgery while on CPB.

2. Exclusive criteriaThe researchers exclude the patients were investigated

before and after cardiac surgery while on CPB.

f Has the study been replicated?

No, the researchers were the first one to study thedeterminants of Cerebral Oxygenation during Cardiac Surgery. But thereare already many studies about cardiac surgery.

g What were the risks and benefits of the nursing action / interventiontested in the study?

The risk of the nursing action is adjusted the estimates of the effectof having cerebral oxygenation during cardiac surgery, but we were unable todirectly assess the effect of timing of onset or clinical severity because datawere not available. The benefits would be to give information to the public thedeterminants of Cerebral Oxygenation during Cardiac Surgery.

V. Result of the study

The results of the study notified that one patient died on the secondpostoperative day because of myocardial infarction due to early graft closure.No patient suffered from

central neurological deficits postoperatively; one

patient had a transient peripheral paresis of the left arm due to operative

placement. Four patients showed transient neuropsychological deficits

postoperatively diagnosed by a score 23 in the Mini-Mental State testobtained from the first through the third postoperative

day. These patients had

a lower minimum CtO2 compared with those without these deficits (-4.5

versus -0.7 µmol/L; P <.05).

All other measured parameters showed nosignificant differences between the groups.

VI. Author’s Conclusion/Recommendations The Author’s conclude that cerebral oxygenation is autoregulated duringcardiac surgery before and after CPB. During CPB, Hb, temperature, pH, andPCO2 determine at least 85% of all changes in cerebral oxygenation. The



main causes of impaired cerebral oxygenation are the decrease in Hb withhemodilution, vasoconstriction due to hypocapnia,

and the leftward shift of the

Hb binding curve in alkalosis and hypothermia.

VII. ApplicabilityDoes the study provide a direct enough answer to your clinical question interms of type of patients, interventions and outcome?

The study did provide a direct answer to the clinical question in terms of typesof patients, interventions, and outcome. It saw also stated that the maincauses of impaired cerebral oxygenation are the decrease

in Hb with

hemodilution, vasoconstriction due to hypocapnia, and the leftward shift of theHb binding curve in alkalosis and hypothermia.

Is it feasible to carry out the nursing action in the real world?

The study is not feasible to carry out the nursing action in real world becausethe variable for this study is insufficient, the efficacy and outcomes of

screening remain unknown and the population, setting and Intervention aretoo broad to carry out the nursing action but It is applicable for the nurses toeducate the person who have cardiac surgery about the determinants ofCerebral Oxygenation.

VIII. Reviewer’s Conclusion/Commentary Studying health is very essential to us. Having more people doing thisresearch benefited not only those with diseases or illnesses but also a healthyindividual especially health care provider by learning.

In this article, the study demonstrates an important issue that arises with largepopulation-based studies. The presence of a statistically significantassociation does not prove causation. Such studies potentially have manyconfounding factors that can cause weak, but statistically significant,associations, as seen here. Overall that study help us to determined thedeterminants of Cerebral Oxygenation during cardiac surgery.

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