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CARDIOVASCULAR ANESTHESIA

Regional Capnometry with Air-Automated Tonometry Detects Circulatory Failure Earlier Than Conventional Hemodynamics After Cardiac Surgery

Gilles Lebuffe, MD^*, Christophe Decoene, MD, Annie Pol, MD, Alain Prat, MD, and Benoit Vallet, MD, PhD^*

*Département d’anesthésie-réanimation II, Hôpital Claude Huriez and Clinique de Chirurgie Cardio-vasculaire, Centre Hospitalier Universitaire, Lille, France

Address correspondence and reprint requests to Benoit Vallet, MD, PhD, Département d’anesthésie-réanimation II, Hôpital Claude Huriez CHU Lille, Place de Verdun, 59037 Lille Cedex, France. Address e-mail to bvallet{at}chru-lille.fr

Gastrointestinal automated online air tonometry has been proposed for monitoring gastric perfusion in patients at risk of circulatory failure (CF) after cardiopulmonary bypass. In this study, CF was prospectively defined as the requirement for vasoactive support to maintain mean arterial pressure 70 mm Hg after optimization of preload. Hemodynamic variables—oxygen (O₂) delivery (DO₂), O₂ uptake (VO₂), venous-to-arterial [P(v-a)CO₂], gastric-to-arterial [P(r-a)CO₂], and gastric-to-end-tidal [P(r-et)CO₂]PCO₂ gap—were retrospectively compared in 14 patients with or without CF during a 12-hr postbypass period (H0–H12). In contrast to patients without CF (n = 7), in patients with CF (n = 7) increased VO₂ was not associated with an increase in DO₂. P(r-a)CO₂ was larger at H0 in CF patients and was the only variable that differed between the two groups. P(v-a)CO₂ did not vary significantly in both groups, whereas P(r-a)CO₂ increased to a larger extent from H0 to H12 in patients with CF, suggesting selective gastrointestinal hypoperfusion in this group. P(r-et)CO₂ provided comparable information to P(r-a)CO₂. Hospital length of stay was 4 days longer (P < 0.05) in patients with CF. Increased P(r-a)CO₂ and P(r-et)CO₂, as monitored with automated air tonometry, were associated with rapid occurrence of CF and prolonged hospital stay after cardiac surgery.

Implications: Regional and automated capnometry may be used noninvasively to identify patients at risk of circulatory failure after cardiopulmonary bypass earlier than with conventional variables.

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