Massive Pulmonary Infarction during Total Cardiopulmonary Bypass in Unanesthetized Spontaneously Breathing Lambs

1981 ◽  
Vol 4 (2) ◽  
pp. 76-81 ◽  
Author(s):  
T. Kolobow ◽  
R.G. Spragg ◽  
J.E. Pierce
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Pulmonary Ventilation ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Pulmonary Infarction ◽  
Cardiopulmonary Support ◽  
Mixed Venous

We provided total cardiopulmonary support for 1-18 hours in unanesthetized tethered lambs by peripheral vascular cannulation, using a roller pump and the spiral membrane lung. Respirations were allowed to remain spontaneous and unaided. A Swan-Ganz catheter was placed for retrograde pulmonary artery blood flow sampling. Within a few minutes following induced ventricular fibrillation the PCO2 of sampled blood flowing retrograde through the lungs fell below 10 mm Hg, the PO2 rose to near 150 mm Hg, the pH rose to above 7.8, and the glucose level fell to less than 20 mg %. All of these values later gradually shifted, approaching mixed venous blood values within minutes. After 1-18 hrs of perfusion the animals went into shock and were sacrificed. At autopsy, the lungs of animals breathing room air were beefy and hemorrhagic. In lambs that were «breathing» CO2 enriched air the retrograde pulmonary artery blood pH and PCO2 was usually maintained close to the mixed venous blood values. The observed pulmonary changes were considerably less abnormal, and the microscopic abnormalities were at times nonexistent. We believe the integrity of pulmonary blood flow is vital to the survival of the lungs as a functioning organ. Cessation of total forward pulmonary blood flow (unlike partial cardiopulmonary bypass), combined with spontaneous pulmonary ventilation, rapidly leads to massive, pulmonary infactions, shock, and death.

Effect of intrapleural pressure on pulmonary shunt through atelectatic dog lung

1963 ◽  
Vol 205 (6) ◽  
pp. 1187-1192 ◽  
Author(s):  
T. N. Finley ◽  
T. R. Hill ◽  
J. J. Bonica
Keyword(s):  
Blood Flow ◽  
Spontaneous Breathing ◽  
Pulmonary Blood Flow ◽  
Venous Blood ◽  
Left Lung ◽  
Mixed Venous Blood ◽  
Pulmonary Shunt ◽  
Intrapleural Pressure ◽  
Flow Through ◽  
Mixed Venous

During spontaneous breathing of oxygen, the pulmonary shunt through the left lung, made atelectatic by occlusion of its airway, was calculated from the O2 and CO2 tension of the arterial and mixed venous blood. At intrapleural pressure swings of -3 to -12 cm H2O, the relative blood flow through the atelectatic lung was reduced to 21.6% of the pulmonary blood flow (normal 45%). With wider swings of intrapleural pressure, average -7.5 to -24 cm H2O, the relative blood flow through the atelectatic lung increased to 45% of the pulmonary blood flow, probably because resistance to blood flow increased in the overdistended right lung. The pulmonary shunt through atelectatic lung varied directly with the increased negativity of the intrapleural pressure.

Pulmonary diffusion in the dog lung

1962 ◽  
Vol 17 (6) ◽  
pp. 885-892 ◽  
Author(s):  
Albert H. Niden ◽  
Charles Mittman ◽  
Benjamin Burrows
Keyword(s):  
Carbon Monoxide ◽  
Pulmonary Artery ◽  
Experimental Animal ◽  
Venous Blood ◽  
Whole Body ◽  
Mixed Venous Blood ◽  
Pulmonary Diffusion ◽  
Perfused Lung ◽  
Pulmonary Arterial ◽  
Mixed Venous

Methods have been presented for assessing pulmonary diffusion by the “equilibration technique” in the experimental intact dog and perfused lung while controlling ventilation with a whole body respirator. No significant change in diffusion of carbon monoxide was noted between open and closed chest anesthetized animals, with duration of anesthesia in the intact dog, or with duration of perfusion of the isolated dog's lung. There was no demonstrable difference in diffusion when arterialized blood was used as the perfusate in place of mixed venous blood in the lung perfusions suggesting that within the range studied the Po2, Pco2, and pH of pulmonary artery blood does not directly affect the diffusion of carbon monoxide. Retrograde perfusions of dogs' lungs did not significantly alter diffusion, suggesting that pulmonary venous resistance was not significantly lower than pulmonary arterial resistance in the perfused dog lung at the flows and pressures studied. The equilibration technique for measuring pulmonary diffusion and assessing the uniformity of diffusion was well suited to the study of pulmonary diffusing characteristics in the experimental animal. Submitted on January 8, 1962

scholarly journals Extracorporeal membrane oxygenation for the control of a pulmonary artery hemorrhage

2021 ◽  
Author(s):  
Yuichiro Hirata ◽  
Eiki Tayama ◽  
Ryuya Nomura ◽  
Tomofumi Fukuda ◽  
Kojiro Furukawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Pulmonary Blood Flow ◽  
Pulmonary Hemorrhage ◽  
Massive Hemoptysis ◽  
Membrane Oxygenation ◽  
The Right

No standard treatments have been established for airway hemorrhage during cardiopulmonary bypass (CPB). Herein, we describe two cases of catheter-induced pulmonary hemorrhage during cardiac surgery. In each case, massive hemoptysis was observed during cardiopulmonary bypass (CPB) weaning. A bronchial blocker was inserted into the right bronchus, and extracorporeal membrane oxygenation (ECMO) was initiated to reduce pulmonary blood flow, and stabilize the hemodynamics. ECMO significantly reduced bleeding from the pulmonary artery (PA). Both cases had favorable outcomes following the implementation of extracorporeal membrane oxygenation (ECMO). ECMO is effective at controlling PA bleeding during and after cardiac surgery.

The depth of anaesthesia associated with the administration of isoflurane 2.5% during cardiopulmonary bypass

Perfusion ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 392-398 ◽  
Author(s):  
R Peter Alston ◽  
Michael Connelly ◽  
Christopher MacKenzie ◽  
George Just ◽  
Natalie Homer
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Venous Blood ◽  
Index Score ◽  
Mixed Venous Blood ◽  
Depth Of Anaesthesia ◽  
Isoflurane Concentration ◽  
Time Points ◽  
Arterial Blood ◽  
Mixed Venous

Background:Administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass results in no patient movement. However, doing so may result in an excessive depth of anaesthesia particularly, when hypothermia is induced. Bispectral index and arterial blood and oxygenator exhaust concentrations of volatile anaesthetics should be related to depth of anaesthesia. The primary aim of this study was to measure the depth of anaesthesia using bispectral index, resulting from administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass, and secondary aims were to examine the relationships between blood and oxygenator exhaust isoflurane concentrations and bispectral index.Methods:Arterial and mixed-venous blood samples were aspirated at three time points during cardiopulmonary bypass and measured for isoflurane concentration using mass spectrometry. Simultaneously, oxygenator exhaust isoflurane concentration, nasopharyngeal temperature and bispectral index were recorded.Results:When averaged across the three time points, all patients had a bispectral index score below 40 (binomial test, p < 0.001). There were no significant correlations between bispectral index score and arterial or mixed-venous blood isoflurane concentrations (r = –0.082, p = 0.715; r = –0.036, p = 0.874) and oxygenator exhaust gas concentration of isoflurane (r = –0.369, p = 0.091).Conclusion:When 2.5% isoflurane was administered into the sweep gas supply to the oxygenator during cardiopulmonary bypass, all patients experienced a bispectral index score less than 40 and no significant relationship was found between either arterial or mixed-venous blood or oxygenator exhaust concentrations of isoflurane and bispectral index.

The relationship between mixed venous and regional venous oxygen saturation during cardiopulmonary bypass

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Lena Lindholm ◽  
Vigdis Hansdottir ◽  
Magnus Lundqvist ◽  
Anders Jeppsson
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Hepatic Vein ◽  
Jugular Vein ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mixed Venous Saturation ◽  
Venous Oxygen Saturation ◽  
The Relationship ◽  
Mixed Venous

The relationship between mixed venous and regional venous saturation during cardiopulmonary bypass (CPB), and whether this relationship is influenced by temperature, has been incompletely elucidated. Thirty patients undergoing valve and/or coronary surgery were included in a prospective, controlled and randomized study. The patients were allocated to two groups: a hypothermic group (28°C) and a tepid group (34°C). Blood gases were analysed in blood from the hepatic vein and the jugular vein and from mixed venous blood collected before surgery, during hypothermia, during rewarming, and 30 min after CPB was discontinued. Oxygen saturation in the hepatic vein was lower than in the mixed venous blood at all times of measurement (-24.0 ± 3.0% during hypothermia, -36.5 ± 2.9% during rewarming, and -30.5 ± 3.0% postoperatively, p < 0.001 at all time points). In 23% of the measurements, the hepatic saturation was < 25% in spite of normal (> 60%) mixed venous saturation. There was a statistical correlation between mixed venous and hepatic vein oxygen saturation (r = 0.76, p < 0.0001). Jugular vein oxygen saturation was lower than mixed venous saturation in all three measurements (-21.6 ± 1.9% during hypothermia, p < 0.001; -16.7 ± 1.9% during rewarming, p < 0.001; and -5.6 ± 2.2% postoperatively, p = 0.037). No significant correlation in oxygen saturation could be detected between mixed venous and jugular vein blood ( r = 0.06, p = 0.65). Systemic temperature did not influence the differences in oxygen saturation between mixed venous and regional venous blood at any time point. In conclusion, regional deoxyge-nation occurs during CPB, in spite of normal mixed venous saturation. Mixed venous oxygen saturation correlates with hepatic, but not with jugular, vein saturation. The level of hypothermia does not influence differences in oxygen saturation between mixed venous and regional venous blood.

Cardiopulmonary Bypass Reduces Early Thrombosis of Systemic-to-Pulmonary Artery Shunts

2018 ◽  
Vol 9 (3) ◽  
pp. 276-282 ◽  
Author(s):  
Jason T. Patregnani ◽  
Anthony A. Sochet ◽  
David Zurakowski ◽  
Darren Klugman ◽  
Yaser Diab ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Fisher Exact Test ◽  
Platelet Dysfunction ◽  
Exact Test ◽  
Shunt Placement ◽  
Shunt Thrombosis ◽  
Multivariable Regression

Background: Shunt thrombosis is a significant cause of morbidity and mortality after systemic-to-pulmonary artery shunt (SPS) placement. Concurrent procedures with placement of SPS may require cardiopulmonary bypass (CPB). Cardiopulmonary bypass is known to cause bleeding and platelet dysfunction in infants, which may protect from early shunt thrombosis. We hypothesized that infants undergoing SPS placement on CPB have a lower incidence of early shunt thrombosis. Methods: Retrospective cohort study of infants undergoing SPS placement from January 2008 to December 2014 was performed. Patients with and without early shunt thrombosis and on or off CPB were compared using the Mann-Whitney U test or Fisher exact test. Multivariable regression analysis was performed to identify independent predictors of early shunt thrombosis and to assess effect of CPB independent of other factors. Results: Seventy-five infants underwent SPS placement during the study period (on CPB, n = 25; off CPB, n = 50). Operative mortality was 11% (8/75). Nine (12%) patients developed early shunt thrombosis, all of whom had shunt placement off CPB. Independent risk factors for early shunt thrombosis were identified to be SPS placement off CPB ( P = .011), prematurity ( P = .034), and competitive antegrade pulmonary blood flow ( P = .038). Conclusion: Prematurity, competitive antegrade pulmonary blood flow, and shunt placement off CPB lead to higher risk of early shunt thrombosis. We speculate that the protection offered by use of CPB may be accounted for by the associated complex coagulopathy and platelet dysfunction associated with CPB.

A nomogram to evaluate the arterial mixed venous oxygen saturation difference during cardiopulmonary bypass

Perfusion ◽  
1998 ◽  
Vol 13 (1) ◽  
pp. 45-51 ◽  
Author(s):  
F Cavaliere
Keyword(s):  
Cardiopulmonary Bypass ◽  
Muscle Relaxation ◽  
Venous Blood ◽  
Myocardial Revascularization ◽  
The Body ◽  
Mixed Venous Blood ◽  
Blood Haemoglobin ◽  
The Difference ◽  
Mixed Venous ◽  
Saturation Difference

A nomogram providing the arterial mixed venous haemoglobin saturation difference (Sa-vO2) corresponding to normal oxygen consumption (VO2) during cardiopulmonary bypass (CPB) was produced. Normal VO2 during CPB (95.8 ± 20.1 ml/min/m2 at 37°C) was obtained from the literature. The nomogram computes the Sa-vO2 from the body surface, pump flow, blood haemoglobin and patient temperature; a table is also presented which supplies the Sa-vO2 ranges corresponding to VO2 mean ±1 and ±2SD. The nomogram was tested on 10 subjects undergoing CPB for myocardial revascularization. Sa-vO2 was determined by arterial and mixed venous blood oximetry 5, 20, and 35 min after the start of CPB. The measured Sa-vO2 was 27.1 ± 7.2% while Sa-vO2 obtained from the nomogram was 24.9 ± 4.0%, the difference was not statistically significant. Eighteen values (60%) were within the range corresponding to VO2 mean ±1SD. One value was lower than the Sa-vO2 value corresponding to VO2 mean - 2SD and was associated with the lowest value of blood haemoglobin. Two values were higher than the Sa-vO2 value corresponding to VO2 mean + 2SD and were associated with inadequate muscle relaxation. By comparing measured Sa-vO2 values with those obtained by the nomogram and the table, anaesthesiologists and perfusionists can easily detect patients presenting abnormally low or high VO2 values.

Dependence of Middle Ear Gas Composition on Pulmonary Ventilation

1997 ◽  
Vol 106 (4) ◽  
pp. 314-319 ◽  
Author(s):  
Haya Mover-Lev ◽  
Moshe Harell ◽  
Dalia Levy ◽  
Amos Ar ◽  
Michal Luntz ◽  
...  
Keyword(s):  
Steady State ◽  
Middle Ear ◽  
Pulmonary Ventilation ◽  
Venous Blood ◽  
Blood Gases ◽  
Mixed Venous Blood ◽  
Gas Composition ◽  
Blood Gas ◽  
Ventilation Perfusion Ratio ◽  
Mixed Venous

The middle ear (ME) steady state gas composition resembles that of mixed venous blood. We changed arterial and venous blood gases by artificially ventilating anesthetized guinea pigs and measured simultaneous ME gas changes during spontaneous breathing, hyperventilation, and hypoventilation. During hyperventilation, PaCO2 and PvCO2 (a = arterial, v = venous) decreased from 46.0 and 53.0 mm Hg to 17.9 and 37.5 mm Hg, respectively, while PaO2 and PvO2 (85.6 and 38.2 mm Hg) did not change. This was accompanied by an ME PCO2 decrease from 70.4 to 58.8 mm Hg and a PO2 decrease from 36.8 to 25.4 mm Hg. During hypoventilation, PaCO2 and PvCO2 increased to 56.8 and 66.4 mm Hg, while PvO2 decreased to 21.8 mm Hg. The ME PCO2 increased simultaneously to 88.8 mm Hg and the ME PO2 decreased to 25.4 mm Hg. The ME PO2 decrease during hyperventilation may be explained by a 33% decrease in ME mucosa perfusion, calculated from the ME ventilation-perfusion ratio. This study shows that ME gas composition follows fluctuations of blood gas levels and thus may affect total ME pressure.

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