A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac Surgery With Cardiopulmonary Bypass

Matthew J. Chan, Luca Lucchetta, Salvatore Cutuli, Christopher Eyeington, Neil J. Glassford, Johan Mårtensson, Peter Angelopoulos, George Matalanis, Lawrence Weinberg, Glenn M. Eastwood, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: To test whether targeted therapeutic mild hypercapnia (TTMH) would attenuate cerebral oxygen desaturation detected using near-infrared spectroscopy during cardiac surgery requiring cardiopulmonary bypass (CPB). Design: Randomized controlled trials. Setting: Operating rooms and intensive care unit of tertiary hospital. Participants: The study comprised 30 patients undergoing cardiac surgery with CPB. Interventions: Patients were randomly assigned to receive either standard carbon dioxide management (normocapnia) or TTMH (target arterial carbon dioxide partial pressure between 50 and 55 mmHg) throughout the intraoperative period and postoperatively until the onset of spontaneous ventilation. Measurements and Main Results: Relevant biochemical and hemodynamic variables were measured, and cerebral tissue oxygen saturation (SctO 2 ) was monitored with near-infrared spectroscopy. Patients were followed-up with neuropsychological testing. Patient demographics between groups were compared using the Fisher exact and Mann-Whitney tests, and SctO 2 between groups was compared using repeated measures analysis of variance. The median patient age was 67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II was 1.1. The median CPB time was 106 minutes. The mean intraoperative arterial carbon dioxide partial pressure for each patient was significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg [IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9 mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004). There was no difference in mean percentage change in SctO 2 during CPB in the control group for both hemispheres (left: –6.7% v –2.3%; p = 0.110; right: –7.9% v –1.0%; p = 0.120). Compliance with neuropsychological test protocols was poor. However, the proportion of patients with drops in test score >20% was similar between groups in all tests. Conclusions: TTMH did not increase SctO 2 appreciably during CPB but increased pulmonary artery pressures before and after CPB. These findings do not support further investigation of TTMH as a means of improving SctO 2 during and after cardiac surgery requiring CPB.

Original languageEnglish
Pages (from-to)2968-2978
Number of pages11
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume33
Issue number11
DOIs
Publication statusPublished - Nov 2019
Externally publishedYes

Keywords

  • cardiac surgery
  • cardiopulmonary bypass
  • hypercapnia
  • near-infrared spectroscopy
  • neuropsychological testing
  • normocapnia
  • pulmonary artery pressure

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