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Publications [#270956] of James A. Blumenthal

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Journal Articles

  1. Croughwell, N; Newman, M; Blumenthal, JA; White, WD; Lewis, JB; Croughwell, ND; Smith, LR; Townsend, EA; Hurwitz, BJ; Leone, BJ; Schell, RM; Reves, JG (1994). Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass. Annals of Thoracic Surgery, 58(6), 1-7. [7979740]
    (last updated on 2019/07/16)

    Abstract:
    Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly (p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption (r = -0.6; p < 0.0005), cerebral blood flow (r = 0.4; p < 0.0005), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial pressure (r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood flow to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.


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