Case presentation

of
bsn 137 – group 148 -B
“Cerebral oxygenation; it is effective
determinants during cardiac surgery? ”

Members:
Alpe, Aldrin Ian Villaseñor, Marijoe A.

Arago, Jericho D. Wilkinson, Tracy I.

Arcenio, Kris Yanto, Pebbie Anne C.

Cabbuag, Jessica Yarcia, Mary Grace B.

Cuevas, Krisslene Zabat, Paolo M.

Garcia, Kristine Jane

Submitted To:

Mr. Frederick Brigino, RN, RM, MAN

September 12, 2010

 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING

Hospital -Based Intervention to

Determinants of cerebral oxygenation during cardiac surgery
(EVIDENCE-BASED NURSING)

I. Clinical Question

Cerebral oxygenation; it is effective determinants during cardiac surgery?

II. Citation

Title: Determinants of Cerebral Oxygenation during Cardiac Surgery

Author: Georg Nollert, MD; Patrick Möhnle, MD; Peter Tassani-Prell, MD

III. Study Characteristics

Patient included:
Forty-one consecutive patients were investigated during cardiac surgery
while on CPB. Operative management included moderate hypothermia of
26°C and the alpha-stat pH management.

Interventions Compared:
Compared the rates with near-infrared spectrophotometry, changes in
oxygenated 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 of
 operative management parameters on cerebral oxygenation was
calculated by univariate and multiple regression analyses.
Outcome monitored:

In show that the outcome before and after CPB there was no significant
multivariate 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).

Does the study focus on a significant problem in clinical setting?

Yes, because the study focuses on a significant problem in a clinical

practice because it can help to determined if the determinants of Cerebral
Oxygenation during Cardiac Surgery

IV. Methodology / Design

a. 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 major
surgery: comparison of coronary artery bypass surgery and peripheral
vascular surgery. Stroke. 1987;18:700-707.

e. Subject selection

1. Inclusion criteria
 The researchers include and studied forty-one consecutive
patients were investigated during cardiac surgery while on CPB.

2. Exclusive criteria

The 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 the

determinants of Cerebral Oxygenation during Cardiac Surgery. But there
are already many studies about cardiac surgery.

g. What were the risks and benefits of the nursing action / intervention
tested in the study?

The risk of the nursing action is adjusted the estimates of the

effect of having cerebral oxygenation during cardiac surgery, but we were
unable to directly assess the effect of timing of onset or clinical severity
because data were not available. The benefits would be to give
information to the public the determinants of Cerebral Oxygenation during
Cardiac Surgery.

V. Results of the study

The results of the study notified that one patient died on the second
postoperative 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 test
obtained 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 no significant
differences between the groups.

VI. Author’s conclusion / recommendation

The Author’s conclude that cerebral oxygenation is autoregulated during

cardiac surgery before and after CPB. During CPB, Hb, temperature, pH, and
PCO2 determine at least 85% of all changes in cerebral oxygenation. The
main causes of impaired cerebral oxygenation are the decrease in Hb with
hemodilution, vasoconstriction due to hypocapnia, and the leftward shift of the
Hb binding curve in alkalosis and hypothermia.

VII. Applicability

1. Does the study provide a direct enough answer to your clinical

question in terms of type of patients, interventions and outcome?

The study did provide a direct answer to the clinical question in terms
of types of patients, interventions, and outcome. It saw also stated that the
main causes of impaired cerebral oxygenation are the decrease in Hb with
hemodilution, vasoconstriction due to hypocapnia, and the leftward shift of
the Hb binding curve in alkalosis and hypothermia.

2. 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 because the variable for this study is insufficient, the efficacy and
 outcomes of screening remain unknown and the population, setting
and Intervention are too broad to carry out the nursing action but It is
applicable for the nurses to educate the person who have cardiac
surgery about the determinants of Cerebral Oxygenation.

VIII. Reviewer’s Conclusion / Commentary

Studying health is very essential to us. Having more people

doing this research benefited not only those with diseases or illnesses but
also a healthy individual especially health care provider by learning.

In this article, the study demonstrates an important issue that

arises with large population-based studies. The presence of a statistically
significant association does not prove causation. Such studies potentially
have many confounding factors that can cause weak, but statistically
significant, associations, as seen here. Overall that study help us to
determined the determinants of Cerebral Oxygenation during cardiac
surgery.