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End-tidal CO2 Should not be a Parameter for Ventilatory Adjustment during Low Cardiac Output States Like Off-pump Coronary Artery Bypass Grafting | OMICS International | Abstract
ISSN: 2329-9126

Journal of General Practice
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Research Article

End-tidal CO2 Should not be a Parameter for Ventilatory Adjustment during Low Cardiac Output States Like Off-pump Coronary Artery Bypass Grafting

Manender Kumar Singla1*, Kanwalpreet Sodhi2, Anupam Shrivastava3, Manpreet Singh Salooja4, Kishore C. Mukherjee4
and Sonia Saini1
1Department of Cardiac Anesthesia, SPS Apollo Hospitals, Ludhiana, India
2Department of Critical Care, SPS Apollo Hospitals, Ludhiana, India
3Department of Anesthesia and Critical Care, SPS Apollo Hospitals, Ludhiana, India
4Department of Cardiothoracic and Vascular Surgery, SPS Apollo Hospitals, Ludhiana, India
Corresponding Author : Dr. Manender Kumar Singla, MD
Consultant, Department of Cardiac Anesthesia
SPS Apollo Hospitals, Ludhiana, India- 141003
Tel: +919465430748
E-mail: [email protected]
Received April 23, 2014; Accepted April 26, 2014; Published April 29, 2014
Citation: Singla MK, Sodhi K, Shrivastava A, Salooja MS, Mukherjee KC (2014) End-tidal CO2 Should not be a Parameter for Ventilatory Adjustment during Low Cardiac Output States Like Off-pump Coronary Artery Bypass Grafting. J Gen Pract 2:159. doi: 10.4172/2329-9126.1000159
Copyright: © 2014 Singla, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: Capnography is widely used as a non-invasive monitoring technique for intra-operative and postoperative mechanically ventilated patients. Aim: To study whether the EtCO2 values should be used to adjust mechanical ventilation during low cardiac output states such as off pump cardiac bypass surgery (OPCABG). Setting and design: Prospective study in 50 patients undergoing OPCABG. Material and Methods: The values of cardiac index (CI), EtCO2, PaCO2 and P(a-Et)CO2 gradient were compared at two time points during OPCABG: immediately before skin incision and during grafting of obtuse marginal artery, as usually OM grafting is considered to be associated with low cardiac output. Statistics: Data was analysed using student’s t-test. Results: There was a significant decrease in the value of CI from point A to point B (2.33 vs. 1.75 L/min/m2, p<0.001), significant decrease in EtCO2 from 25.28 to 21.88mmHg (p<0.001) and statistically significant increase in P(a-Et)CO2 gradient 4.39 at point A to 9.18 mmHg at point B (p<0.003). Conclusion: The decrease in EtCO2 had a positive correlation with the decrease in cardiac index. So during the low flow periods as found in OPCABG, EtCO2 cannot reliably estimate the adequacy of ventilation.

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