J Clin Monit Comput - States of low pulmonary blood flow can be detected non-invasively at the bedside measuring alveolar dead space.

Tópicos

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Resumo

We tested whether the ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)) can detect states of low pulmonary blood flow (PBF) in a non-invasive way. Fifteen patients undergoing cardiovascular surgeries with cardiopulmonary bypass (CPB) were studied. CPB is a technique that excludes the lungs from the general circulation. The weaning of CPB is a model that manipulates PBF in vivo because each time blood flow through the CPB decreases, expected PBF (ePBF) increases. Patients were liberated from CPB in steps of 20 % every 2' starting from 100 % CPB (very low ePBF) to 0 % CPB (100 % ePBF). During constant ventilation, volumetric capnograms were recorded and Bohr's dead space ratio (VD(Bohr)/VT), VD(alv)/VT(alv) and the ratio of airway dead space to tidal volume (VD(aw)/VT) were calculated. Before CPB, VD(Bohr)/VT was 0.36 ? 0.05, VD(aw)/VT 0.21 ? 0.04 and VD(alv)/VT(alv) 0.18 ? 0.06 (mean ? SD). During weaning from CPB, VD(aw)/VT remained unchanged while VD(Bohr)/VT and VD(alv)/VT(alv) decreased with increasing ePBF. At CPB of 80, 60, 40 and 20 % VD(Bohr)/VT was 0.64 ? 0.06, 0.55 ? 0.06, 0.47 ? 0.05 and 0.40 ? 0.04, respectively; p < 0.001 and VD(alv)/VT(alv) 0.53 ? 0.07, 0.40 ? 0.07, 0.29 ? 0.06 and 0.25 ? 0.04, respectively; p < 0.001). After CPB, VD(Bohr)/VT and VD(alv)/VT(alv) reached values similar to baseline (0.37 ? 0.04 and 0.19 ? 0.06, respectively). At constant ventilation the alveolar component of VD(Bohr)/VT increased in proportion to the deficit in lung perfusion.

Resumo Limpo

test whether ratio alveolar dead space alveolar tidal volum vdalvvtalv can detect state low pulmonari blood flow pbf noninvas way fifteen patient undergo cardiovascular surgeri cardiopulmonari bypass cpb studi cpb techniqu exclud lung general circul wean cpb model manipul pbf vivo time blood flow cpb decreas expect pbf epbf increas patient liber cpb step everi start cpb low epbf cpb epbf constant ventil volumetr capnogram record bohr dead space ratio vdbohrvt vdalvvtalv ratio airway dead space tidal volum vdawvt calcul cpb vdbohrvt vdawvt vdalvvtalv mean sd wean cpb vdawvt remain unchang vdbohrvt vdalvvtalv decreas increas epbf cpb vdbohrvt respect p vdalvvtalv respect p cpb vdbohrvt vdalvvtalv reach valu similar baselin respect constant ventil alveolar compon vdbohrvt increas proport deficit lung perfus

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