Delivery of oxygen during cardiopulmonary bypass and associated clinical outcomes among adult cardiac surgery patients: A systematic review
Bibliographic record
Abstract
Purpose Oxygen delivery (DO 2 ) during cardiopulmonary bypass (CPB) is critical in preventing postoperative complications in adult cardiac surgery. This systematic review aimed to assess the relationship between intraoperative DO 2 during CPB, particularly within Goal-directed Perfusion (GDP) strategies, and associated clinical outcomes. Methods A systematic search of MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, PROSPERO, and Cochrane was conducted from database inception through December 2024, adhering to PRISMA 2020 guidelines. Studies reported intraoperative DO 2 measurements and their relationship with clinical outcomes among adults undergoing cardiac surgery with CPB. Data extraction and quality assessment were performed independently by two reviewers. Results Thirty-nine studies (71,050 patients) were included, with acute kidney injury (AKI) being the most frequently studied outcome (84.6% of studies). A consistent association was found between lower intraoperative DO 2 and increased risk of AKI, intraoperative lactate elevations, and prolonged mechanical ventilation. Five randomized controlled trials (RCTs) demonstrated that maintaining DO 2 levels, indexed to body surface area (iDO 2 ), above a threshold of 270–300 mL/min/m 2 significantly reduced the risk of postoperative AKI. However, evidence linking DO 2 management directly to reductions in mortality or neurologic complications remains limited, as well as studies reporting compliance with GDP strategies. Conclusion Maintaining adequate iDO 2 during CPB significantly reduces postoperative complications, especially AKI. These findings underscore the clinical relevance of GDP strategies, highlighting the importance of individualized perfusion management to optimize outcomes. Further large-scale RCTs are needed to confirm these benefits, standardize specific iDO 2 threshold levels that are beneficial, and to explore strategies that impact mortality and neurologic outcomes, as well as investigate the role that temperature management plays in DO 2 threshold determination.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.006 |
| Bibliometrics | 0.009 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".