Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgry

Four mature horses were used to test the effects of two doses (50 and 200 mg) of intravenously administered cocaine on hemodynamics and selected indexes of performance [maximal heart rate (HRmax), treadmill velocity at HRmax, treadmill velocity needed to produce a blood lactate concentration of 4 mmol/l, maximal mixed venous blood lactate concentration, maximal treadmill work intensity, and test duration] measured during an incremental treadmill test. Both doses of cocaine increased HRmax approximately 7% (P < 0.05). Mean arterial pressure was 30 mmHg greater (P < 0.05) during the 4- to 7-m/s steps of the exercise test in the 200-mg trial. Neither dose of cocaine had an effect on the responses to exertion of right atrial pressure, right ventricular pressure, or maximal change in right ventricular pressure over time. Maximal mixed venous blood lactate concentration increased 41% (P < 0.05) with the 50-mg dose and 75% (P < 0.05) with the 200-mg dose during exercise. Administration of cocaine resulted in decreases (P < 0.05) in the treadmill velocity needed to produce a blood lactate concentration of 4 mmol/l from 6.9 +/- 0.5 and 6.8 +/- 0.9 m/s during the control trials to 4.4 +/- 0.1 m/s during the 200-mg cocaine trial. Cocaine did not alter maximal treadmill work intensity (P > 0.05); however, time to exhaustion increased by approximately 92 s (15%; P < 0.05) during the 200-mg trial.(ABSTRACT TRUNCATED AT 250 WORDS)

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PERIODIC ANALYSIS OF MIXED VENOUS OXYGEN TENSION TO MONITOR THE ADEQUACY OF PERFUSION DURING AND AFTER CARDIOPULMONARY BYPASS

Survey of Anesthesiology ◽

10.1097/00132586-197508000-00028 ◽

1975 ◽

Vol 19 (4) ◽

pp. 350

Author(s):

T. H. STANLEY ◽

J. ISERN-AMARAL

Keyword(s):

Cardiopulmonary Bypass ◽

Oxygen Tension ◽

Periodic Analysis ◽

Mixed Venous

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Increases in coronary vein CO2 during cardiac resuscitation

Journal of Applied Physiology ◽

10.1152/jappl.1990.68.4.1405 ◽

1990 ◽

Vol 68 (4) ◽

pp. 1405-1408 ◽

Cited By ~ 26

Author(s):

C. V. Gudipati ◽

M. H. Weil ◽

R. J. Gazmuri ◽

H. G. Deshmukh ◽

J. Bisera ◽

...

Keyword(s):

Spontaneous Circulation ◽

Co2 Production ◽

Acid Base ◽

Coronary Vein ◽

Arterial Pco2 ◽

Control Value ◽

Great Cardiac Vein ◽

Aortic Blood ◽

Highly Correlated ◽

Mixed Venous

We investigated the aortic, mixed venous, and great cardiac vein acid-base changes in eight domestic pigs during cardiac arrest produced by ventricular fibrillation and during cardiopulmonary resuscitation (CPR). The great cardiac vein PCO2 increased from a control value of 52 +/- 2 to 132 +/- 28 (SD) Torr during CPR, whereas the arterial PCO2 was unchanged (39 +/- 4 vs. 38 +/- 4). The coronary venoarterial PCO2 gradient, therefore, increased remarkably from 13 +/- 2 to 94 +/- 29 Torr. The simultaneously measured great cardiac vein lactate concentrations increased from 0.24 +/- 0.06 to 7.3 +/- 2.34 mmol/l. Much more moderate increases in the lactate content of aortic blood from 0.64 +/- 0.25 to 2.56 +/- 0.27 mmol/l were observed. Increases in great cardiac vein PCO2 and lactate were highly correlated during CPR (r = 0.91). After successful CPR, the coronary venoarterial PCO2 gradient returned to normal levels within 2 min after restoration of spontaneous circulation. Lactate content was rapidly reduced and lactate extraction was reestablished within 30 min after CPR. These studies demonstrate marked but reversible acidosis predominantly as the result of myocardial CO2 production during CPR.

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Alternative peripheral perfusion strategies for safe cardiopulmonary bypass in atrial septal defect closure via a right minithoracotomy approach

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-015-0611-2 ◽

2015 ◽

Vol 64 (3) ◽

pp. 131-137 ◽

Cited By ~ 6

Author(s):

Hiroto Kitahara ◽

Kazuma Okamoto ◽

Mikihiko Kudo ◽

Akihiro Yoshitake ◽

Takahito Ito ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Atrial Septal Defect ◽

Septal Defect ◽

Defect Closure ◽

Peripheral Perfusion ◽

Atrial Septal Defect Closure

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Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

World Journal of Cardiovascular Surgery ◽

10.4236/wjcs.2014.47020 ◽

2014 ◽

Vol 04 (07) ◽

pp. 131-138

Author(s):

Ganapathy Sambandam Kamalakkannan ◽

Ranjith Karthekeyan ◽

Mahesh Vakamudi ◽

Sandeep Bangale ◽

Rajeshkumar Kodali ◽

...

Keyword(s):

Oxygen Saturation ◽

Blood Lactate ◽

Mixed Venous Oxygen Saturation ◽

Off Pump ◽

Venous Oxygen Saturation ◽

Pump Cabg ◽

Mixed Venous

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Effect of analyzer on determination of mixed venous PCO2 and cardiac output during exercise

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.3.1032 ◽

1995 ◽

Vol 79 (3) ◽

pp. 1032-1038 ◽

Cited By ~ 8

Author(s):

L. Hornby ◽

A. L. Coates ◽

L. C. Lands

Keyword(s):

Cardiac Output ◽

Gas Mixture ◽

Arterial Pco2 ◽

Venous Pco2 ◽

The Face ◽

High O2 ◽

Collision Broadening ◽

Rebreathing Methods ◽

Mixed Venous

Cardiac output (CO) during exercise can be determined noninvasively by using the indirect Fick CO2-rebreathing technique. CO2 measurements for this technique are usually performed with an infrared analyzer (IA) or mass spectrometer (MS). However, IA CO2 measurements are susceptible to underreading in the face of high O2 concentrations because of collision broadening. We compared an IA (Ametek model CD-3A) with a MS (Marquette model MGA-1100) to see the effect this would have on mixed venous PCO2 (PVCO2) and CO measurements. After calibration with room air and a gas mixture of 5% CO2–12% O2–83% N2, both devices were tested with three different gas mixtures of CO2 in O2. For each gas mixture, IA gave lower CO2 values than did the MS (4.1% CO2: IA, 3.85 +/- 0.01% and MS, 4.13 +/- 0.01%; 9.2% CO2: IA, 8.44 +/- 0.07% and MS, 9.19 +/- 0.01%; 13.8% CO2: IA, 12.57 +/- 0.15% and MS, 13.82 +/- 0.01%). Warming and humidifying the gases did not alter the results. The IA gave lower values than did the MS for eight other medical gases in lower concentrations of O2 (40–50%). Equilibrium and exponential rebreathing procedures were performed. Values determined by the IA were > 10% higher than those determined by the MS for both rebreathing methods. We conclude that all IAs must be checked for collision broadening if they are to be used in environments where the concentration of O2 is > 21%. If collision broadening is present, then either a special high O2-CO2 calibration curve must be constructed, or the IA should not be used for both arterial PCO2 and PVCO2 estimates because it may produce erroneously low PVCO2 values, with resultant overestimation of CO.

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Gas-blood PCO2 gradients during avian gas exchange

Journal of Applied Physiology ◽

10.1152/jappl.1975.39.3.405 ◽

1975 ◽

Vol 39 (3) ◽

pp. 405-410 ◽

Cited By ~ 20

Author(s):

D. G. Davies ◽

R. E. Dutton

Keyword(s):

Gas Exchange ◽

Exchange System ◽

Arterial Pco2 ◽

Charged Membrane ◽

Venous Pco2 ◽

Avian Lung ◽

Gas Exchange System ◽

Spontaneously Breathing ◽

Membrane Mechanism ◽

Mixed Venous

The avian respiratory system is a crosscurrent gas exchange system. One of the aspects of this type of gas exchange system is that end-expired PCO2 is greater than arterial PCO2, the highest possible value being equal to mixed venous PCO2. We made steady-state measurements of arterial, mixed venous, and end-expired PCO2 in anesthetized, spontaneously breathing chickens during inhalation of room air or 4–8% CO2. We found end-expired PCO2 to be higher than both arterial and mixed venous PCO2, the sign of the differences being such as to oppose passive diffusion. The observation that end-expired PCO2 was higher than arterial PCO2 can be explained on the basis of crosscurrent gas exchange. However, the observation that end-expired PCO2 exceeded mixed venous PCO2 must be accounted for by some other mechanism. The positive end-expired to mixed venous PCO2 gradients can be explained if it is postulated that the charged membrane mechanism suggested by Gurtner et al. (Respiration Physiol. 7: 173–187, 1969) is present in the avian lung.

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Blood Lactate Level as Predictor of Early Outcome after Cardiac Surgery under Cardiopulmonary Bypass

University Heart Journal ◽

10.3329/uhj.v13i2.37659 ◽

2018 ◽

Vol 13 (2) ◽

pp. 50-54

Author(s):

Md Abul Kalam Azad ◽

Md Abul Quashem ◽

Md Rezaul Karim ◽

Md Kamrul Hasan

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Lactate ◽

Lactate Level ◽

Prolonged Mechanical Ventilation ◽

Blood Lactate Level ◽

Binary Logistic Regression Analysis ◽

Early Outcome ◽

Icu Transfer ◽

Adult Cardiac Surgery

We examined the hypothesis that high blood lactate level in ICU patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether blood lactate level after cardiac surgery is predictor of the early outcome after adult cardiac surgery under CPB. In this prospective observational study total 100 patients were enrolled who underwent elective cardiac surgery under CPB as per inclusion and exclusion criteria. Blood lactate levels > 3mmol/ L 6 hours after ICU transfer were present in 57(57%) patients. The binary logistic regression analysis showed that blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time (OR 2.417, 95% CI 1.272 - 4.596, p = .007), prolonged ICU stay (OR 1.562, 95% CI 1.181 - 2.067, p = .002), neurological deficit (OR 2.432, 95% CI 1.539 - 3.843, p = .001), pulmonary complication (OR 1.301, 95% CI 1.011 - 1.676, p = .041), arrhythmia (OR 1.444, 95% CI 1.102 - 1.893, p = .008), renal dysfunction (OR 1.838, 95% CI 1.352 - 2.497, p = .001) and mortality (OR 1.822, 95% CI 1.123- 2.955, p = .015). In conclusion, blood lactate level 6 hours after ICU transfer is an independent risk factor for worse outcomes in adult patients including mortality after cardiac surgery under CPB.University Heart Journal Vol. 13, No. 2, July 2017; 50-54

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