Cerebral Carbon Dioxide Reactivity during Nonpulsatile Cardiopulmonary Bypass

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.

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Effects of Prostaglandin E1 or Trimethaphan on Local Cerebral Blood Flow and Carbon Dioxide Reactivity During Cerebral Aneurysm Surgery

Journal of Neurosurgical Anesthesiology ◽

10.1097/00008506-199307000-00003 ◽

1993 ◽

Vol 5 (3) ◽

pp. 143-150 ◽

Cited By ~ 3

Author(s):

Kazuo Abe ◽

Ikuto Yoshiya

Keyword(s):

Carbon Dioxide ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Cerebral Aneurysm ◽

Prostaglandin E1 ◽

Aneurysm Surgery ◽

Local Cerebral Blood Flow ◽

Carbon Dioxide Reactivity

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Carbon Dioxide Reactivity of the Cerebral Circulation in Extremely Premature Infants: Effects of Postnatal Age and Indomethacin

Pediatric Research ◽

10.1203/00006450-198808000-00007 ◽

1988 ◽

Vol 24 (2) ◽

pp. 175-179 ◽

Cited By ~ 48

Author(s):

Malcolm I Levene ◽

David Shortland ◽

N Gibson ◽

David H Evans

Keyword(s):

Carbon Dioxide ◽

Premature Infants ◽

Cerebral Circulation ◽

Carbon Dioxide Reactivity

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Clinical evaluation of an instrument to measure carbon dioxide tension at the oxygenator gas outlet in cardiopulmonary bypass

Perfusion ◽

10.1191/0267659106pf842oa ◽

2006 ◽

Vol 21 (1) ◽

pp. 21-26 ◽

Cited By ~ 5

Author(s):

Frode Kristiansen ◽

Jan Olav Høgetveit ◽

Thore H Pedersen

Keyword(s):

Carbon Dioxide ◽

Cardiopulmonary Bypass ◽

Venous Blood ◽

Carbon Dioxide Tension ◽

Circuit Board ◽

Separate Analysis ◽

Blood Gas ◽

Arterial Blood ◽

Gas Measurement ◽

Venous Blood Gas

This paper presents the clinical testing of a new capno-graph designed to measure the carbon dioxide tension at the oxygenator exhaust outlet in cardiopulmonary bypass (CPB). During CPB, there is a need for reliable, accurate and instant estimates of the arterial blood CO2 tension (PaCO2) in the patient. Currently, the standard practice for measuring PaCO2 involves the manual collection of intermittent blood samples, followed by a separate analysis performed by a blood gas analyser. Probes for inline blood gas measurement exist, but they are expensive and, thus, unsuitable for routine use. A well-known method is to measure PexCO2, ie, the partial pressure of CO2 in the exhaust gas output from the oxygenator and use this as an indirect estimate for PaCO2. Based on a commercially available CO2 sensor circuit board, a laminar flow capnograph was developed. A standard sample line with integrated water trap was connected to the oxygenator exhaust port. Fifty patients were divided into six different groups with respect to oxygenator type and temperature range. Both arterial and venous blood gas samples were drawn from the CPB circuit at various temperatures. Alfa-stat corrected pCO2 values were obtained by running a linear regression for each group based on the arterial temperature and then correcting the PexCO2 accordingly. The accuracy of the six groups was found to be (±SD): ±4.3, ±4.8, ±5.7, ±1.0, ±3.7 and ±2.1%. These results suggest that oxygenator exhaust capnography is a simple, inexpensive and reliable method of estimating the PaCO2 in both adult and pediatric patients at all relevant temperatures.

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The effects of carbon dioxide management on plasma levels of fentanyl and sufentanil during hypothermic cardiopulmonary bypass

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/1053-0770(94)90196-1 ◽

1994 ◽

Vol 8 (6) ◽

pp. 649-652

Author(s):

David A. Cross ◽

Demitris Nikas

Keyword(s):

Carbon Dioxide ◽

Cardiopulmonary Bypass ◽

Plasma Levels ◽

Hypothermic Cardiopulmonary Bypass

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High-dose Remifentanil Does Not Impair Cerebrovascular Carbon Dioxide Reactivity in Healthy Male Volunteers

Anesthesiology ◽

10.1097/00000542-200310000-00014 ◽

2003 ◽

Vol 99 (4) ◽

pp. 834-840 ◽

Cited By ~ 27

Author(s):

Walter Klimscha ◽

Roman Ullrich ◽

Christian Nasel ◽

Wolfgang Dietrich ◽

Udo M. Illievich ◽

...

Keyword(s):

Carbon Dioxide ◽

High Dose ◽

Healthy Male ◽

Duration Of Action ◽

Remifentanil Infusion ◽

Healthy Male Volunteers ◽

Male Volunteers ◽

Carbon Dioxide Reactivity ◽

Cerebrovascular Carbon Dioxide Reactivity ◽

Relative Change

Background Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv). Methods Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 microg x kg-1 x min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively. If required, blood pressure was maintained within baseline values with intravenous phenylephrine to avoid confounding effects of altered hemodynamics. Results Hemodynamic parameters were maintained constant over time. Remifentanil infusion at 2 and 4 microg x kg-1 x min-1 significantly decreased rCBF and mean CBFv. Both rCBF and mean CBFv increased as the arterial carbon dioxide tension increased from hypocapnia to hypercapnia, indicating that cerebrovascular reactivity remained intact. The average slopes of rCBF reactivity were 0.56 +/- 0.27 and 0.49 +/- 0.28 ml. 100 g-1 x min-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.9 +/- 0.8 and 1.6 +/- 0.5, respectively). The average slopes for mean CBFv reactivity were 1.61 +/- 0.95 and 1.54 +/- 0.83 cm x s-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.86 +/- 0.59 and 1.79 +/- 0.59, respectively). Preanesthesia and postanesthesia values of rCBF and mean CBFv did not differ. Conclusion High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.

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A Randomized Study of Carbon Dioxide Management during Hypothermic Cardiopulmonary Bypass

Anesthesiology ◽

10.1097/00000542-199001000-00003 ◽

1990 ◽

Vol 72 (1) ◽

pp. 7-15 ◽

Cited By ~ 80

Author(s):

G. Bashein ◽

Brenda D. Townes ◽

Michael L. Nessly ◽

Stephen W. Bledsoe ◽

Thomas F. Hornbein ◽

...

Keyword(s):

Carbon Dioxide ◽

Cardiopulmonary Bypass ◽

Randomized Study ◽

Hypothermic Cardiopulmonary Bypass

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35% Carbon Dioxide Reactivity In A Bulimia Nervosa Sample

10.32920/ryerson.14657763 ◽

2021 ◽

Author(s):

Andrea Woznica

Keyword(s):

Carbon Dioxide ◽

Eating Disorder ◽

Bulimia Nervosa ◽

Vital Capacity ◽

Distress Tolerance ◽

Self Report ◽

Discomfort Intolerance ◽

State And Trait Anxiety ◽

Carbon Dioxide Reactivity ◽

Anxiety Depression

This study extended research on the specificity of the effects of the carbon dioxide (CO₂) challenge by examining panic reactivity in participants with bulimia nervosa (BN) (n=15) compared to those without bulimia nervosa (n=31). All participants completed self-report measures assessing state and trait anxiety, depression, anxiety sensitivity (AS), distress tolerance (DT), discomfort intolerance (DI), and eating disorder features. They subsequently breathed two vital capacity inhalations; room air and 35% CO₂-enriched air. Reactivity to room air was not different between groups. However, participants with BN displayed greater reactivity to CO₂ compared to the participants with BN. AS, DI, and DT could not be tested as potential mediators in the association between diagnostic group and reactivity because these constructs were not associated with reactivity. Eating disorder features and frequency of binges and purges were also not associated with reactivity. Detailed implications and suggestions for further research are discussed.

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