The effects of continuous blood gas monitoring during cardiopulmonary bypass: a prospective, randomized study--Part II.

摘要

The impact of blood gas management during cardiopulmonary bypass (CPB) on patient care has not been examined and remains controversial. The purpose of this study was to determine whether precise blood gas management during CPB influences patient outcome. Fifty-nine patients were enrolled in an Institutional Review Board-approved, prospective, randomized study. An in-line blood gas monitor (CDI 500) was placed into the arterial and venous lines for all patients. Blood gas monitoring in the control group was managed by intermittent sampling (every 20-30 min), while the treatment group was managed with continuous monitoring. Blood gas control and measured parameters were as follows: pH 7.40 +/- 0.05, PaCO2 40 +/- 5 mmHg, PaO2 200 +/- 50 mmHg. The treatment group had the CDI 500 guide clinical decisions. Compared to the control group, the treatment group consisted of significantly more diabetic (7% vs. 47%, p < or = 0.001), renal failure (3% vs. 13%, p < or = 0.01), and chronic obstructive pulmonary disease patients (7% vs. 20%, p < or = 0.01). Internal thoracic artery utilization was higher in treatment patients than control patients (67% vs. 95%, p < or = 0.02). No other differences existed in demographic, pharmacological, surgical, or anesthetic parameters. In the perioperative period, the control group required antiarrythmic support more frequently than the treatment group (10% vs. 0%, p < or = 0.05). Compared to the control group, the treatment group required antiarrythmic (18% vs. 10%, p < or = 0.05) and cardiac glycoside therapy (11% vs. 0%, p < or = 0.05) less frequently in the postoperative period. Although treatment patients required less intraoperative pacing and cardioversion and spent less time on mechanical ventilation, in the intensive care unit (ICU), and in the hospital than control patients, statistical significance was not achieved. In conclusion, the use of continuous, in-line blood gas monitoring resulted in improvement in a number of postoperative outcome variables, although ICU and hospital stay was not effected.