Effect of mild hypothermia during cardiopulmonary bypass on erythrocytic hemoglobin oxygen delivery.

OBJECTIVES: To observe and define the degree of change in hemoglobin oxygen affinity induced by hypothermic extracorporeal circulation (ECC). DESIGN: A prospective, nonrandomized, observational study. SETTING: A single university medical center. PARTICIPANTS: Seventeen patients presenting for elective cardiac surgery. INTERVENTIONS: Systemic hypothermia during ECC. MEASUREMENTS AND MAIN RESULTS: During and after ECC, simultaneous arterial and mixed-venous whole-blood samples were obtained and immediately analyzed for gas tensions and hemoglobin saturation. Samples were obtained during the following times on ECC: initially after cardiopulmonary bypass onset during normothermia (37 degrees C), after cooling to 32 degrees C, and after rewarming to 37 degrees C. A fourth sample was obtained 10 to 20 minutes after discontinuation of cardiopulmonary bypass. Extracorporeal pump flow and thermodilution-determined cardiac output were also recorded for calculation of oxygen delivery and consumption. Mixed-venous results were used to calculate in vivo the blood gas tension at which hemoglobin was 50% saturated with oxygen (P50). There were no differences in P50 for the 17 patients by analysis of variance (ANOVA) for repeated measures with paired t-test with Bonferroni correction. Furthermore, no change in P50 was observed during the course of cooling and rewarming in any individual patient's samples. Oxygen delivery decreased after hypothermia and rewarming from mild hypothermia; oxygen consumption was decreased after rewarming and markedly increased after discontinuation from ECC. CONCLUSION: Mild hypothermia to 32 degrees C during ECC does not result in in vivo alterations in oxyhemoglobin dissociation and thus does not induce changes in oxygen delivery to peripheral tissues. However, oxygen usage appears to be markedly increased after cardiopulmonary bypass.

Hemodynamic monitoring in respiratory care.

Continuous, invasive hemodynamic monitoring of patients in respiratory failure is an important aspect of total respiratory care. Understanding both the technical and physiological principles underlying hemodynamic monitoring is therefore important for respiratory care practitioners. This review is designed to meet this need by (1) addressing the technical aspects of hemodynamic monitoring (catheters, transducers, and monitors), (2) discussing the determinants of commonly measured hemodynamic variables (intravascular pressures and cardiac output), and (3) offering an orderly approach to hemodynamic data that allows for rapid determination of the patient's physiologic state and appropriate diagnostic possibilities. These principles are illustrated by five examples.