Influence of arterial carbon dioxide tension on systemic vascular resistance in patients undergoing cardiopulmonary bypass

BuhreM.D, W.; Weyland, A.; Grüne, Frank; derVelde, J. van; Schorn, B.; Kazmaier, S.; Sonntag, H.

doi:10.1111/j.1399-6576.1998.tb05103.x

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…The findings of our study are quite contrary to that of Buhre and colleagues (23) who concluded that SVR under c~ star' acid base management is higher than under 'pH stat' management. The drawback of the study done by Buhre and colleagues (23) was that it was performed in a randomized cross over design and each patient served as his own control.…”

Section: Discussioncontrasting

confidence: 99%

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Arterial blood gas management during cardiopulmonary bypass

Sanjay

Devnath

Thejas

2005

Indian J Clin Biochem

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This study sought to investigate the effects of cr and pH stat regimens on cardiac outcome during moderate hypothermic cardiopulmonary bypass. 100 patients undergoing elective coronary artery bypass grafting (CABG) were randomly assigned with respect to the target value for PaCO 2 during cardiopulmonary bypass (CPB) into 2 groups. In 50 patients the target PaCO 2 was 40 mmHg, measured at a standard electrode temperature of 37 o C while in the other 50 patients the target PaCO= was 40 mmHg, corrected to the patients nasopharyngeal temperature (lowest value reached: 32 + 0.5~163 There were no significant differences between groups with regards to cardiac outcome such as appearance of new 'Q' waves on the electrocardiogram, postoperative creatinine kinase-MB fraction, systemic vascular resistance (SVR), cardiac index (CI), need for inotropic or intra-aortic balloon pump support and the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO 2 management during CPB at moderate hypothermia has no clinically significant effect on cardiac outcome.

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Section: Discussioncontrasting

confidence: 99%

“…The drawback of the study done by Buhre and colleagues (23) was that it was performed in a randomized cross over design and each patient served as his own control. Secondly the target values for cr stat' and 'pH stat' management were not reached.…”

Section: Discussionmentioning

confidence: 99%

Arterial blood gas management during cardiopulmonary bypass

Sanjay

Devnath

Thejas

2005

Indian J Clin Biochem

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“…A decrease in capillary hydrostatic pressure is likely to be caused by intensive peripheral sympathetic vasoconstriction 22,29 and venous dilatation from CO2 retention. 30 The observed cell counts in the present study were corrected for plasma volume changes and, therefore, the increases in RBCV and WBC were not due to haemoconcentration (on the contrary, haemodilution was observed) but were, rather, caused, at least in part, by splenic contraction. 7,31 In the present study, an increase in RBCV in response to serial breath holds in professional divers and intact subjects without diving experience was found.…”

Section: Discussionmentioning

confidence: 94%

Effect of Human Splenic Contraction on Variation in Circulating Blood Cell Counts

Baković

Eterović

Saratlija-Novaković

et al. 2005

Clin Exp Pharma Physio

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1. The human spleen sequesters 200-250 mL densely packed red blood cells. Up to 50% of this viscous blood is actively expelled into the systemic circulation during strenuous exercise or simulated apnoea (breath-hold) diving. The contribution of splenic contraction to changes in the circulating volume of red blood cells (RBCV), as well as the venous concentration of white blood cells (WBC) and platelets (PLT), was investigated following repeated breath-hold apnoeas. 2. Eighteen trained apnoea divers and 18 intact and six splenectomized subjects without diving experience repeated five maximal apnoeas with face immersion in cold water, with 2 min intervals between successive attempts. Venous blood samples were taken before and between consecutive apnoeas, as well as at 0, 10 and 20 min after the last breath hold. Arterial pressure, heart rate and transcutaneous partial pressure of oxygen and carbon dioxide were monitored continuously. 3. Plasma protein concentration decreased by 5.8, 2.2 and 9% in apnoea divers, untrained and splenectomized subjects, respectively, indicating an expansion of plasma volume. The RBCV and venous concentration of WBC, corrected for changes in plasma volume, increased in both trained apnoea divers (4.9+/-1.0 and 14.9+/-3.1%, respectively) and intact subjects (1.7+/-0.8 and 7.2+/-1.8%, respectively), whereas in splenectomized subjects there was no change in RBCV and a delayed increase in WBC concentration. Furthermore, an initial lymphocytosis detected during repeated breath holds in divers and intact subjects was completely absent in splenectomized subjects. None of the groups showed significant changes in PLT concentrations. The well-recognized diving response to apnoea (bradycardia and increased blood pressure) was seen during all breath-hold attempts in all subjects. 4. Repeated breath-holds (apnoeas) contribute to increased RBCV and venous blood concentrations of WBC through splenic contraction.

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“…1 Cerebral autoregulation is a complex physiologic mechanism, which is influenced by several factors including hematocrit and p a CO 2 . 21,22 Ono et al studied cerebral autoregulation during CPB and found increased p a CO 2 levels to be a factor of negative influence. 15 As indicated by the authors' data, dCA was reduced with a lower hematocrit ( Table 3).…”

Section: Discussionmentioning

confidence: 98%