• Arthur Neuschwander, Severine Couffin, Thi Mum Huynh, Bernard Cholley, Gabrielle Pinot de Villechenon, Paul Achouh, Jean Noel Fabiani, Denis Safran, and Romain Pirracchio.
• Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
• J. Cardiothorac. Vasc. Anesth. 2015 Aug 1; 29 (4): 917-23.

ObjectiveThere are no available criteria for determining the optimal flow rate and mean arterial pressure level in patients undergoing cardiopulmonary bypass (CPB). Transcutaneous carbon dioxide tension (PtCO2) has been proposed for microcirculation monitoring and it could be useful for guiding hemodynamic optimization under CPB. The goal of this exploratory study was to determine the factors that influence PtCO2 variations during CPB.DesignCutaneous ear lobe CO2 tension was monitored along with hemodynamic parameters every 10 minutes during CPB, until aortic unclamping.SettingFrench university teaching hospital.ParticipantsPatients scheduled for cardiac surgery requiring CPB were prospectively included.InterventionNone.Measurements And Main ResultsA total of 41 patients were included (520 observations). There was a statistically significant association between PaCO2 and PtCO2 (beta = 0.493 [0.154-0.832], p = 0.043), mostly when PaCO2 was outside the normal range. When PaCO2 was normal, PtCO2 was inversely correlated with mean arterial pressure (after adjustment for PaCO2 and body temperature: Beta -0.245, SE = 0.037, p<0.001) but not with CPB flow rate (p = 0.11).ConclusionThe factors that influence PtCO2 during CPB cardiac surgery are PaCO2, body temperature, and mean arterial pressure. When PaCO2 is normal, a PtCO2 elevation might be explained by insufficient mean arterial pressure. Whether low PtCO2 values during CPB should trigger the administration of vasoconstrictors remains to be evaluated.Copyright © 2015 Elsevier Inc. All rights reserved.

26 keywords...

hide…