Systemic effects of carbon dioxide insufflation technique for de-airing in left-sided cardiac surgery

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• 作者：Maya L ; enhed ; Faleh Al-Rashidi ; Sten Blomquist ; Peter H枚glund ; Leif Pierre ; Bansi Koul
• 关键词：CO2 ; carbon dioxide ; CPB ; cardiopulmonary bypass ; LV ; left ventricle ; rSO2 ; regional cerebral oxygen saturation ; SEM ; scanning electron microscopy ; TCD ; transcranial Doppler sonography
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：January, 2014
• 年：2014
• 卷：147
• 期：1
• 页码：295-300
• 全文大小：768 K

文摘

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Objective

Systemic effects of carbon dioxide (CO₂) insufflation during left-sided cardiac surgery were evaluated in a prospective randomized study, with regard to acid-base status, gas exchange, cerebral hemodynamics, and red blood cell morphology.

Methods

Twenty patients undergoing elective left-sided cardiac surgery were randomized to de-airing procedure either by CO₂ insufflation technique (CO₂ group, n聽=聽10) or by Lund technique without CO₂ insufflation (Lund group, n聽=聽10). Groups underwent assessment of acid-base status by intermittent arterial blood gases and in-line blood gas monitoring. Capnography was used to determine volume of CO₂ produced. Cerebral hemodynamics was measured by transcranial Doppler sonography and near-infrared spectroscopy. Red cell morphology from cardiotomy suction and vent tubing was studied by scanning electron microscopy.

Results

Patients in the CO₂ group consequently developed significantly higher levels of hypercapnia with a concomitant increase in the volume of CO₂ produced despite significantly higher oxygenator gas flows compared with the Lund group. Effects on cerebral hemodynamics were observed in the CO₂ group with significantly higher blood flow velocities in the middle cerebral artery and higher regional cerebral saturation. Red blood cell damage was observed in the CO₂ group by scanning electron microscopy (97% in CO₂ group vs 18% in Lund group).

Conclusions

Insufflation of CO₂ into the cardiothoracic wound cavity during left-sided cardiac surgery can induce hypercapnic acidosis and increased cerebral blood flow and local blood cell damage. These systemic effects should be monitored by in-line capnography and acid-base measurements for early and effective correction by increase in gas flows to the oxygenator.