On-line measurement of gas-exchange during cardiac surgery

Abstract

This paper describes an on-line system for continuously monitoring expired CO2 during controlled ventilation. Signals from a Servo ventilator 900B or C and a CO2 Analyzer 930 are processed and corrected by the computer to produce a CO2 single breath test (SBT-CO2). This is the tracing of expired CO2 concentration or fraction against expired volume, from which the computer calculates the airway deadspace (VDaw). If a value for arterial PCO2 is supplied, the computer will calculate the physiological deadspace (VDphys) and the alveolar deadspace (VDalv) for each breath. The system was used to make measurements at four stages during coronary artery by-pass grafting in 13 male patients. When the sternum was opened there was a 32% increase in VDaw, and the physiological deadspace fraction therefore increased. There were reductions in VDaw after extra-corporeal circulation and again after sternal suture. By the end of surgery, the alveolar deadspace fraction had increased significantly. VDaw at this stage was smaller than pre-operatively, and so there was no net change in the physiological deadspace fraction at the end of surgery. Arterial PO2 was, however, reduced at this stage.