. Author manuscript; available in PMC: 2017 Jul 19.

Published in final edited form as: J Thorac Cardiovasc Surg. 2016 Sep 19;153(1):118–125.e1. doi: 10.1016/j.jtcvs.2016.09.016

TABLE 1.

Pilot goal-directed perfusion initiative (goal-directed perfusion guidelines)

Goal	Intervention
Minimize CPB circuit volume	Use Sorin Inspire oxygenator (LivaNova, London, United Kingdom)
	Use 3/8″ instead of 1/2″ tubing if possible for venous line
	Position CPB circuit closer to OR table
Avoid “stress” on kidneys	Avoid mannitol in CPB prime
Avoid hypovolemia	Avoid RAP or ensure<10% decrease in MAP or NIRS if using RAP
Avoid hypovolemia	Return all CPB perfusate to patient
Ensure tissue oxygenation	Maintain DO2>300 mL O2/min/m² BSA
Ensure tissue oxygenation	Monitor NIRS data to maintain at baseline
Reduce inflammatory cytokines and coagulation factor consumption	Use hemoconcentrator and ZBUF
	Use heparin drip on CPB
Avoid splanchnic vasoconstriction	Minimize phenylephrine use, increase CPB flow first if possible
Limit rapidity of rewarming	Rewarm no faster than 1°C every 5 min
Limit rapidity of rewarming	Maintain temperature differential between arterial and venous blood<3°C

CPB, Cardiopulmonary bypass; OR, operating room; RAP, retrograde autologous priming; MAP, mean arterial pressure; NIRS, near-infrared spectroscopy; DO2, oxygen delivery; BSA, body surface area; ZBUF, zero-balance ultrafiltration.