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The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 239-248, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LS Fox, EH Blackstone, JW Kirklin, RW Stewart and PN Samuelson
Whole body oxygen consumption (Vo2) and its relationship to randomly
selected arterial perfusion flow rates (Q) during profoundly hypothermic
(20 degrees C) cardiopulmonary bypass were determined in 17 adult patients
undergoing routine coronary artery bypass operations. Vo2 falls
progressively as Q decreases, from 33 +/- 8.2 ml . min(-1) . m(-2) at Q of
2.0 L . min(-1) . m(-2) to 28 +/- 5.8 at Q of 1.5, 25 +/- 5.7 at Q of 1.0,
20 +/- 4.1 at Q of 0.5, and 14 +/- 5.4 at Q of 0.25. This progressive
decrease suggests shutdown of areas of the microcirculation. The upper 70%
confidence limit overlaps the asymptote at Qs above 1.2. Percent oxygen
extraction increases progressively as Q decreases, from 11 +/- 3.3% at Q of
2.0 to 45 +/- 9.6% at Q of 0.25, suggesting reduced reserves. Mixed venous
Po2 and oxygen saturation fall linearly with decreasing Q below 1.2 (r =
0.78 and r = 0.89, p less than 0.0001, respectively), suggesting decreasing
flow to perfused areas. Internal jugular venous Po2 and oxygen saturation
(measured in 10 patients) fall linearly with decreasing Q below 1.8 (r =
0.72 and r = 0.88, p less than 0.0001, respectively), suggesting decreasing
flow to perfused areas of the brain and a difference from the rest of the
body in its behavior with decreasing Q. Thus, during cardiopulmonary bypass
cerebral blood flow, autoregulation seems present at 20 degrees C. The data
set indicates that flows of about 1.2 may be adequate despite limited
reserves.
ARTICLES
Relationship of whole body oxygen consumption to perfusion flow rate during hypothermic cardiopulmonary bypass
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