Changes in nonlinear dynamic complexity measures of blood pressure during anesthesia for cardiac surgeries using cardio pulmonary bypass
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Nonlinear complexity measures computed from beat-to-beat arterial BP dynamics have shown associations with standard cardiac surgical risk indices. They reflect the physiological adaptability of a system and has been proposed as dynamical biomarkers of overall health status. We sought to determine the impact of anesthetic induction and cardiopulmonary bypass (CPB) upon the complexity measures computed from perioperative BP time series. In this prospective, observational study, 300 adult patients undergoing cardiac surgery were included. Perioperative period was divided as: (1) Preoperative (PreOp); (2) ORIS—induction to sternotomy; (3) ORSB- sternotomy to CPB; (4) ORposB—post CPB and within 30 min before leaving OR and (5) postoperative phase (PostOp)—initial 30 min in the cardiac surgical intensive care unit. BP waveforms for systolic (SAP), diastolic (DAP), mean arterial pressure (MAP) and pulse pressure (PP) were recorded, and their corresponding complexity index (MSE∑) was calculated. Significant decrease in MSE∑ from Preop to PostOp phases was observed for all BP time series. Maximum fall was seen during post anesthetic induction (ORIS) phase. Mild recovery during the subsequent phases was observed but they never reached the baseline values. In an exploratory analysis, preoperative MSE∑ showed a significant correlation with postoperative length of ICU stay. Blood pressure complexity varies at different time points and is not fixed for a given individual. Preoperative BP Complexity decreased significantly following anesthetic induction and did not recover to baseline until 30 min after surgery. Prevention of this significant fall may offer restoration of MSE∑ throughout surgery. Furthermore, preoperative BP complexity needs to be explored as a predictor of major postoperative adverse events by itself or in addition with the current risk indices.
KeywordsCardiopulmonary bypass Blood pressure variability Complexity Multiscale entropy Non-linear analysis
BS, TH, VR, PM, RD, MM: Conception or design of the work; acquisition, analysis and interpretation of data. VR, TH, BS, PM, RD, MM: Drafting and revising work for important intellectual content. VR, BS, TH, PM, RD, MM: Final approval of the version to be published. BS, VR, TH, PM, RD, MM: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
BS is supported by the National Institute of Health, Research Project Grant GM 098406.
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Conflicts of interest
The authors declare no competing interests or conflicts of interests.
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