Early non invasive detection of hypercarbia in two cardiac surgical patients

Chakravarthy, Murali; Narayan, Sandeep; Govindarajan, Raghav; Subramanyam, Rajeev; Jawali, Vivek

doi:10.1007/s10877-009-9164-1

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…If this proved to be the case, we wished to explore which factors were associated with an elevated P a CO 2 . Furthermore, on physiological grounds [5][6][7] and with early clinical evidence 8 , we hypothesised that hypercarbia might have the particularly detrimental adverse effect of increasing pulmonary artery pressure. By exploring the other possible influences on pulmonary artery pressure we sought to determine whether any such association was independent of confounding.…”

mentioning

confidence: 99%

Variability in Adequacy of Ventilation during Transport of Cardiac Surgery Patients: A Cohort Study

Rajasekaram

Reade

Shortal

et al. 2011

Anaesth Intensive Care

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Inadequate ventilation of intubated patients during transport from the operating theatre to the intensive care unit with attendant hypercarbia may adversely affect haemodynamics. In a retrospective observational study, we assessed the incidence of inadequate ventilation during transport from the operating theatre to the intensive care unit in 99 consecutive cardiac surgery patients admitted to our university tertiary hospital. Demographic, clinical, arterial blood gas and haemodynamic measurements were made on arrival in the intensive care unit after cardiac surgery. The relationships between arterial carbon dioxide tension (P a CO 2), mean pulmonary artery pressure (MPAP) and other relevant haemodynamic variables were explored. Overall, hypocarbia (P a CO 2 <35 mmHg) occurred in 18.2% of patients, while 28.3% of patients had hypercarbia (P a CO 2 >45 mmHg). Pulmonary hypertension was common, with nearly half of the cohort having MPAP ≥25 mmHg and 17.2% ≥30 mmHg. However, there was no association between P a CO 2 and MPAP (R 2 =0.0076, P=0.39). Contrary to expectation, neither hypercarbia nor high MPAP were associated with measured adverse outcomes, although this may have been because we studied an insufficient number of patients with extreme values. Associations of higher MPAP, which would be expected to compromise cardiovascular status, included acidaemia, hypoxia and the requirement for noradrenaline. These factors define a group of high-risk patients who should receive particular attention and who should be the focus of future studies.

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confidence: 99%

Variability in Adequacy of Ventilation during Transport of Cardiac Surgery Patients: A Cohort Study

Rajasekaram

Reade

Shortal

et al. 2011

Anaesth Intensive Care

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“…This shift in techniques rapidly permitted the innovation of portable gas chromatographs [22] for outreach to population studies [23,24] and the use of lower oral doses of lactose, even in their natural food forms of milk and yogurt [25,26]. More recently, bloodless transcutaneous sensors for blood gases and pH values [27][28][29] have emerged as additional examples of noninvasive technology innovations. The notion of Indonesian workers in the 1990s [30] was to provide a method of selecting those individuals within a population most in need of iron intervention and thus target the administration of a nutrient with recognized adverse effects to those in need [31].…”

Section: Discussionmentioning

confidence: 99%

Correspondence of Hemoglobin Values Obtained by a Noninvasive, Cutaneous-Contact Method with Values Obtained by Conventional Methods from Whole Blood Samples in a Guatemalan Field Setting

Crowley¹,

Montenegro-Bethancourt²,

Arriaga³

et al. 2010

Food Nutr Bull

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Background. Anemia is a widespread public health issue, conventionally diagnosed by analyzing the hemoglobin concentration in whole blood samples. Aspects of safety, comfort, and cultural acceptability would be obviated if reliable, noninvasive anemia screening were available.Objective. To determine day-to-day variations within subjects in hemoglobin measurements and the correspondence of hemoglobin values obtained by a noninvasive, photometric, cutaneous-contact method with values obtained by conventional methods from blood samples. Methods. The hemoglobin level was determined in 40 pregnant women from the Guatemalan coastal plain (low values) and 40 men from the highlands (high values).Hemoglobin concentrations (g/dl) were measured in an automated cell counter and, in parallel, estimated with the use of the Rad-87™ Rainbow pulse CO-Oximeter placed over the nail bed of the ring finger.Results. The mean value for invasively determined hemoglobin was 13.5 g/dl, as compared with 12.2 and 12.1 g/dl for the noninvasive nail-bed estimate at 10 and 5 minutes, respectively. Measurements using the noninvasive technology were highly stable within days and from day to day. The noninvasive screening method showed satisfactory sensitivity and specificity at hemoglobin concentrations of < 12.0 g/dl (cutoff value for nonpregnant women) and < 13.0 g/dl (cutoff value for adult men). Diagnostic discrimination was poorer for the lower cutoff criteria; the anemia cutoff values were < 11.5 g/dl for school-age children and < 11.0 g/dl for pregnant women and children under 5 years of age.Conclusions. Noninvasive hemoglobin screening shows considerable promise, although improvement of sensitivity and specificity in the anemic range and determination periods of less than 10 minutes are desirable.

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Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study

Chakravarthy

Narayan

Govindarajan

et al. 2009

J Clin Monit Comput

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Early non invasive detection of hypercarbia in two cardiac surgical patients

Cited by 4 publications

References 5 publications

Variability in Adequacy of Ventilation during Transport of Cardiac Surgery Patients: A Cohort Study

Variability in Adequacy of Ventilation during Transport of Cardiac Surgery Patients: A Cohort Study

Correspondence of Hemoglobin Values Obtained by a Noninvasive, Cutaneous-Contact Method with Values Obtained by Conventional Methods from Whole Blood Samples in a Guatemalan Field Setting

Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study

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