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  • 1
    Electronic Resource
    Electronic Resource
    Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgry (1991)
    Springer
    Intensive care medicine 17 (1991), S. 320-324 
    Details
    ISSN: 1432-1238
    Keywords: Blood lactate ; Acid base balance ; Cardiopulmonary bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO2 tensions (V-aCO2 gradient) has been shown to reflect critical reductions in systemic and pulmonary blood flow that occur during cardiorespiratory arrest and septic shock. We therefore measured plasma lactate levels and V-aCO2 gradients in 10 patients (mean age 57.2 years) following CPB and compared them with conventional indices of tissue perfusion. Plasma lactate levels, cardiac index (CI) and oxygen uptake $$(\dot VO_2 )$$ all increased significantly (p〈0.05 vs baseline levels) up to 3h following surgery. Oxygen delivery $$(\dot DO_2 )$$ did not change. Plasma lactate levels correlated significantly with CI (r=0.47,p〈0.01). V-aCO2 fell significantly with time (p〈0.01 vs baseline). There was an inverse relationship between V-aCO2 and cardiac index and V-aCO2 and lactate (r=−0.37,p〈0.05;r=−0.3,p〈0.05 respectively). We conclude that blood lactate, CI and $$\dot VO_2 $$ increase progressively following CPB. An increase in lactate was associated with a decrease in V-aCO2. An increase in V-aCO2 was not therefore associated with evidence of inadequate tissue perfusion as indicated by an increased blood lactate concentration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01716189
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Transpulmonary gradient of type III procollagen peptides: Acute effects of cardio-pulmonary bypass (1992)
    Springer
    Intensive care medicine 18 (1992), S. 290-292 
    Details
    ISSN: 1432-1238
    Keywords: Procollagen peptides ; Cardiopulmonary bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Type III procollagen N-peptides (PIIINPs) are believed to be released in stoichiometric amounts as type III collagen molecules are secreted from cells. We hypothesized that if the human lung actively produces type III collagen a detectable transpulmonary gradient in PIIINPs would exist in normal individuals that might be altered following a pulmonary insult. PIIINPs were therefore measured by radioimmunoassay in serum taken simultaneously from the pulmonary artery (PA) and left ventricle/aorta (LV) in 11 patients undergoing routine cardiac catheterisation. Mean PIIINP levels±SEM in LV were 66.8±5.4 μg·ml−1 and 59.9±4.1 μg·ml−1 in PA (p〈0.04). In 6 patients, repeat measurements taken 4 h after cardiopulmonary bypass revealed a significant fall in PA values to 43.8±2.6 μg·ml−1 (p〈0.001) and abolition of the transpulmonary gradient. These results suggest the adult human lung actively synthesis type III collagen and that, in the short term, cardiopulmonary bypass inhibits this process.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01706477
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Gastrointestinal permeability following cardiopulmonary bypass: a randomised study comparing the effects of dopamine and dopexamine (1997)
    Springer
    Intensive care medicine 23 (1997), S. 510-516 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiopulmonary bypass ; Gastrointestinal permeability ; Dopexamine ; Dopamine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To compare the effects of dopexamine and dopamine on the mucosal permeability of the gastrointestinal tract (GIT). Design: Prospective, randomised clinical trial. Setting: Intensive care unit of a postgraduate teaching hospital, London, England. Patients: Thirty patients undergoing elective surgery involving cardiopulmonary bypass, performed by a single surgeon. Interventions: Patients were randomly assigned to receive either dopexamine 2.0 μg/kg per min or dopamine 2.5 μg/kg per min for the duration of the study period. Measurements and main results: Hemodynamic parameters and gastric intramucosal pH (pHi) were measured at intervals throughout the study. GIT permeability was measured once, post-operatively, using the ratio of absorbed lactulose to L-rhamnose. The groups were similar with respect to demographics, pre- and post-operative risk factors. The lactulose/rhamnose ratio was (mean ± SEM) 0.44 ± 0.10 in the dopexamine group vs 0.65 ± 0.08 in that receiving dopamine (p 〈 0.05). The dopexamine group had a significantly higher oxygen delivery preoperatively (479.5 ± 32.0 ml/min per m2 vs 344.4 ± 23.9 ml/min per m2 for dopamine, p 〈 0.01), but no other significant differences emerged between the groups. Conclusions: Compared to dopamine, dopexamine reduces GIT permeability following surgery involving cardiopulmonary bypass. The mechanism of this effect remains unclear.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050366
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    Paper (German National Licenses)
    Fulltext
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