Oxygenator exhaust capnography as an index of arterial carbon dioxide tension during cardiopulmonary bypass using a membrane oxygenator |
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Authors: | O'Leary M J MacDonnell S P Ferguson C N |
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Institution: | Department of Anaesthesia, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK |
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Abstract: | We have studied the relationship between the partial pressure of carbon
dioxide in oxygenator exhaust gas (PECO2) and arterial carbon dioxide
tension (PaCO2) during hypothermic cardiopulmonary bypass with non-
pulsatile flow and a membrane oxygenator. A total of 172 paired
measurements were made in 32 patients, 5 min after starting cardiopulmonary
bypass and then at 15-min intervals. Additional measurements were made at
34 degrees C during rewarming. The degree of agreement between paired
measurements (PaCO2 and PECO2) at each time was calculated. Mean difference
(d) was 0.9 kPa (SD 0.99 kPa). Results were analysed further during stable
hypothermia (n = 30, d = 1.88, SD = 0.69), rewarming at 34 degrees C (n =
22, d = 0, SD = 0.84), rewarming at normothermia (n = 48, d = 0.15, SD =
0.69) and with (n = 78, d = 0.62, SD = 0.99) or without (n = 91, d = 1.07,
SD = 0.9) carbon dioxide being added to the oxygenator gas. The difference
between the two measurements varied in relation to nasopharyngeal
temperature if PaCO2 was not corrected for temperature (r2 = 0.343, P =
< 0.001). However, if PaCO2 was corrected for temperature, the
difference between PaCO2 and PECO2 was not related to temperature, and
there was no relationship with either pump blood flow or oxygenator gas
flow. We found that measurement of carbon dioxide partial pressure in
exhaust gases from a membrane oxygenator during cardiopulmonary bypass was
not a useful method for estimating PaCO2.
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