{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:00:34Z","timestamp":1793444434383,"version":"4.5.0"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100019256","name":"NIHR GOSH BRC","doi-asserted-by":"crossref","award":["(23HL18)"],"award-info":[{"award-number":["(23HL18)"]}],"id":[{"id":"10.13039\/501100019256","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) seeks to match oxygen delivery with patient-specific metabolic demand, yet determinants of oxygen demand and dynamics of oxygen extraction ratio (OER) are not well characterised in paediatric populations. Building on our GARIX (Global AutoRegressive Integrated model with eXogenous variables and an equilibrium force) model from Part 1, we analysed minute-level intraoperative data to derive clinical insights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      GARIX integrates autoregressive memory, exogenous clinical variables (cardiac index, haemoglobin, arterial oxygen saturation, temperature), and an equilibrium component defining indexed oxygen demand (tVO\n                      <jats:sub>2<\/jats:sub>\n                      i) as a function of age, weight, and temperature. We applied GARIX to 20,443 minutes of data from 293 paediatric CPB procedures to study: (1) age- and weight-related variation in oxygen demand; (2) temperature dependence of demand, estimating local and interval Q\n                      <jats:sub>10<\/jats:sub>\n                      ; (3) age-stratified OER responses to haemoglobin and other variables; and (4) time evolution of the mismatch between oxygen consumption and demand after step changes in oxygen delivery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      tVO\n                      <jats:sub>2<\/jats:sub>\n                      i followed a non-monotonic pattern, rising from birth to \u223c3 years and declining thereafter. Metabolic demand decreased nonlinearly with temperature, with a 17% reduction from 37\u00b0C to 32\u00b0C and 39% further reduction to 27\u00b0C. Local Q\n                      <jats:sub>10<\/jats:sub>\n                      ranged from \u223c1.3 near normothermia to \u223c3.8 in deep hypothermia. OER responsiveness to haemoglobin was blunted in neonates and infants compared with older children. Simulations revealed transient over- and under-oxygenation following step changes in oxygen delivery due to lags in OER adaptation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We identify risks of over- and under-oxygenation during CPB despite normal OER readings, challenge the use of fixed targets and constant Q\n                      <jats:sub>10<\/jats:sub>\n                      , and highlight age- and weight-dependent dynamics. These findings support individualised, time-aware perfusion strategies and lay the groundwork for model-guided decision support and control.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251385838","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T07:00:42Z","timestamp":1760425242000},"page":"947-956","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Towards goal-directed perfusion - Part II: Temperature dependence of Q\n                    <sub>10<\/sub>\n                    , oxygen-demand dependence on age and weight, further clinical insights"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3808-277X","authenticated-orcid":false,"given":"Mansour T. A.","family":"Sharabiani","sequence":"first","affiliation":[{"name":"Imperial College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7932-6681","authenticated-orcid":false,"given":"Alireza S.","family":"Mahani","sequence":"additional","affiliation":[{"name":"New York Stock Exchange, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6299-2557","authenticated-orcid":false,"given":"Richard W.","family":"Issitt","sequence":"additional","affiliation":[{"name":"UCL"},{"name":"Great Ormond Street Hospital for Children"},{"name":"Great Ormond Street Hospital for Children"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadav","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Great Ormond Street Hospital for Children"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Bottle","sequence":"additional","affiliation":[{"name":"Imperial College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban","family":"Stoica","sequence":"additional","affiliation":[{"name":"Bristol Royal Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Kirklin\/barratt-boyes cardiac surgery: expert consult-online and print (2-Volume set)","author":"Kirklin JK","year":"2012","unstructured":"Kirklin JK, Blackstone EH. Kirklin\/barratt-boyes cardiac surgery: expert consult-online and print (2-Volume set). Elsevier Health Sciences, 2012."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1550-2783-2-2-32"},{"key":"e_1_3_4_4_2","first-page":"5","article-title":"Predicting basal metabolic rate, new standards and review of previous work","volume":"39","author":"Schofield WN","year":"1985","unstructured":"Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 1985; 39 Suppl 1: 5\u201341.","journal-title":"Hum Nutr Clin Nutr"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/43.12.1113"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004311-196408000-00017"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1949.160.1.125"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004311-196408000-00011"},{"issue":"1","key":"e_1_3_4_9_2","first-page":"220","article-title":"The relationship of oxygen consumption, perfusion rate, and temperature to the acidosis associated with cardiopulmonary circulatory bypass","volume":"44","author":"Clowes GH","year":"1958","unstructured":"Clowes GH, Neville WE, Sabga G, et al. The relationship of oxygen consumption, perfusion rate, and temperature to the acidosis associated with cardiopulmonary circulatory bypass. Surgery 1958; 44(1): 220\u2013239.","journal-title":"Surgery"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)37303-9"},{"key":"e_1_3_4_11_2","first-page":"73","article-title":"Hypothermie","volume":"2","author":"Linder F","year":"1958","unstructured":"Linder F. Hypothermie. Progr Surg 1958; 2: 73. cited by Thauer, von R, and Brendel, W (1962).","journal-title":"Progr Surg"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.3109\/14017436809131900"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023022385"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0708160104"},{"key":"e_1_3_4_15_2","first-page":"27","article-title":"Red blood cell storage lesion: causes and potential clinical consequences","volume":"17","author":"Yoshida T","year":"2019","unstructured":"Yoshida T, Prudent M, D'Alessandro A. Red blood cell storage lesion: causes and potential clinical consequences. Blood Transfus 2019; 17: 27\u201352.","journal-title":"Blood Transfus"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.R114.557314"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251385838","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591251385838","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251385838","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:57:10Z","timestamp":1787302630000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591251385838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/02676591251385838"],"URL":"https:\/\/doi.org\/10.1177\/02676591251385838","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}