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Difficult separation from cardiopulmonary bypass and deltaPCO2.
A Denault1, S Bélisle, D Babin
1Department of Anesthesiology, Research Center, Montreal Heart Institute, Quebec, Canada. denault@videotron.ca
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|February 28, 2001
Summary
Elevated deltaPCO2 during cardiac surgery is common and can predict difficult separation from bypass. Monitoring these gradients may indicate adequate tissue perfusion.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Physiology
Background:
- Veno-arterial and regional differences in partial pressure of CO2 (deltaPCO2) can indicate cardiac output adequacy relative to oxygen consumption.
- Assessing deltaPCO2 may offer insights into tissue perfusion during cardiopulmonary bypass (CPB).
Purpose of the Study:
- To determine the incidence of elevated deltaPCO2 in patients undergoing cardiac surgery.
- To investigate the relationship between elevated deltaPCO2 and difficult separation from bypass (DSB).
Main Methods:
- A prospective observational cohort study involving 58 patients undergoing cardiac operations requiring CPB.
- Arterial and venous blood gases and lactate levels were sampled at multiple time points: pre-anesthesia, during bypass, and at chest closure.
- DSB was defined by specific hemodynamic criteria during CPB weaning, including low systolic pressure, high diastolic pulmonary artery pressure, or need for circulatory support.
Main Results:
- 65% of samples exhibited elevated deltaPCO2 (> 6 mmHg).
- Variables linked to DSB included left ventricular ejection fraction (LVEF), duration of bypass and aortic cross-clamping, pre-bypass deltaPCO2, and in-bypass lactate.
- Multivariable analysis identified pre-bypass deltaPCO2 and bypass duration as significant predictors of DSB.
Conclusions:
- Elevated deltaPCO2 is frequently observed during cardiac surgery.
- Pre-bypass deltaPCO2 levels are associated with DSB, suggesting its utility as an early indicator.
- DeltaPCO2 gradients may serve as a valuable marker for assessing tissue perfusion adequacy during cardiac surgery.