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Temperature and Ventilation after Hypothermic Cardiopulmonary Bypass

The Department of Anesthesia, Stanford University School of Medicine, Stanford, California.

Abstract

Rewarming in the postoperative period after hypothermic cardiopulmonary bypass is often associated with hemodynamic and ventilatory instability. Temperature changes, paco₂ values, and delivered mechanical ventilation were observed for the first 12 hr in the intensive care unit in 73 patients who had undergone cardiac surgery with hypothermic cardiopulmonary bypass. Mean rectal temperature increased from 34.7 to 38.3°C over the first 8 hr after admission to the intensive care unit (P < 0.001). The temperature curve was sigmoid rather than linear., and the most rapid rate of temperature increase occurred 2–4 hr after admission. During rewarming, the most common abnormality of paco₂ on mechanical ventilation was acute respiratory acidosis (paco₂ > 45 mm Hg, pH < 7.35), which occurred in 42% of patients. This suggests that ventilatory management in the early postoperative period after hypothermic cardiopulmonary bypass should be carefully adjusted to the increased metabolic rate during rapid rewarming

Key Words: ANESTHESIA—cardiovascular. • HYPOTHERMIA—anesthetic.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999