Intraoperative hemodynamic monitoring, blood gas and electrolyte management, and temperature management during bypass.
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- What is the most direct way to monitor arterial pressure during CPB?
- An invasive arterial line (radial or femoral) connected to a pressure transducer
- Why is central venous pressure monitoring useful during cardiac surgery even though the heart may be arrested?
- It helps assess venous return, volume status, and right heart function before and after separation from bypass
- What monitoring modality provides continuous real-time imaging of cardiac chambers and valve function during surgery?
- Transesophageal echocardiography (TEE)
- What is the purpose of near-infrared spectroscopy (NIRS) monitoring during CPB?
- Providing a noninvasive estimate of regional cerebral (and sometimes somatic) tissue oxygen saturation
- What does a sustained drop in NIRS cerebral saturation during bypass suggest?
- Inadequate cerebral perfusion or oxygen delivery, prompting evaluation of flow, pressure, cannula position, or oxygenation
- What are the three most common sites used for core temperature monitoring during CPB?
- Nasopharyngeal, bladder, and rectal temperature probes
- Why is nasopharyngeal temperature often used as an estimate of brain temperature?
- Its anatomic proximity to the brain makes it a reasonable, though imperfect, surrogate for cerebral temperature
- Why can bladder or rectal temperature lag behind actual core temperature during rapid cooling or rewarming?
- These sites reflect deeper, more slowly equilibrating tissue compartments with lower blood flow than the brain
- What arterial line parameter, when it rises unexpectedly during bypass, suggests cannula malposition, aortic dissection, or line obstruction?
- Arterial line pressure
- What venous reservoir parameter is continuously watched to detect inadequate venous drainage?
- Venous reservoir volume (level)
- What does inline arterial and venous blood gas monitoring allow the perfusionist to track continuously?
- Oxygenation (PaO2, SvO2), ventilation (PaCO2), and acid-base status during bypass without waiting for intermittent lab draws
- What is a normal target PaO2 range typically maintained on CPB?
- Roughly 150 to 300 mmHg, avoiding both hypoxemia and excessive hyperoxia
- What is a typical target PaCO2 range maintained during CPB?
- Approximately 35 to 45 mmHg, adjusted for the chosen blood gas management strategy
- How is PaCO2 adjusted on the CPB circuit?
- By changing the sweep gas flow rate through the oxygenator or adjusting the fraction of CO2 blended into the sweep gas
- How is PaO2 primarily adjusted on the CPB circuit?
- By adjusting the fraction of inspired oxygen (FiO2) in the sweep gas delivered to the oxygenator
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