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J Thorac Cardiovasc Surg 1995;110:875-0875
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Perioperative use of carbon dioxide production in cardiac surgery

Institut Cardiovasculaire Paris Sud
66 rue du Colonel Fabien
92160 Antony, France

To the Editor:

In the November 1994 issue of the JOURNAL, Feng and Singh ¹ reported the use of end-tidal carbon dioxide tension as an index of cardiac output. They monitored end-tidal carbon dioxide to facilitate weaning from cardiopulmonary bypass in adults having cardiac operations.

This approach seems to be quite reductive, because a more extensive evaluation can be obtained by adding the following (generally available) metabolic and ventilatory parameters: arterial oxygen tension, arterial carbon dioxide tension, mixed expiratory partial pressure of carbon dioxide, arterial-alveolar carbon dioxide gradient (obtained from arterial carbon dioxide tension and end-tidal carbon dioxide), alveolar-arterial oxygen gradient (evaluated with an inspired oxygen tension of 0.5), oxygen consumption, carbon dioxide production, compliance per kilogram of body weight (from the ventilator measurements tidal volume/plateau pressure in milliliters per centimeter of water per kilogram of body weight), and rest energy expenditure (REE = carbon dioxide production x 5.52). All these parameters can be monitored both during the operation and during the postoperative period, to obtain a more comprehensive evaluation of the metabolic, ventilatory, and circulatory situations.

Literature reports exist on this type of monitoring, particularly with regard to postoperative evaluation in adult cardiac surgery. ^2,3 In pediatric cardiac surgery, the aforementioned methods of monitoring have been used to differentiate among the perioperative variations after correction of congenital heart defects with preoperative left-to-right shunt, with right-to-left shunt, or without intracardiac shunt. In fact, such methods have been reported in this JOURNAL. ⁴

Therefore, monitoring of end-tidal carbon dioxide tension not only should be used as a routine evaluation in adult and pediatric cardiac surgery, but also should be applied to more complex situations (e.g., assisted mechanical circulation, unusual palliative procedures) to expand the horizon of its potential use.

References

1. Feng WC, Singh AK. Intraoperative use of end-tidal carbon dioxide tension to assess cardiac output. J THORAC CARDIOVASC SURG 1994;108:991-2.[Free Full Text]
   
2. Chiara O, Giomarelli P, Biagioli B, Rosi R, Gattinoni L. Hypermetabolic response after hypothermic cardiopulmonary bypass. Crit Care Med 1987;15:1071-5.
   
3. Corno A, Giomarelli P, Biagioli B, Barbini P, Grossi A. Postoperative cardiopulmonary monitoring with a computer-based system. J Am Coll Cardiol 1990;15:260A.
   
4. Giomarelli P, Biagioli B, Lisi G, Santoro F, Corno A. On-line metabolic and ventilatory monitoring in pediatric cardiac operations. J THORAC CARDIOVASC SURG 1989;97:939-40.[Medline]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio Corno Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Corno, A. Search for Related Content PubMed PubMed Citation Articles by Corno, A.