Cerebral Oxygen Saturation Graded Response to Carbon Dioxide with Isoxia and Graded Response to Oxygen with Isocapnia.docVIP

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Cerebral Oxygen Saturation Graded Response to Carbon Dioxide with Isoxia and Graded Response to Oxygen with Isocapnia.doc

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Cerebral Oxygen Saturation Graded Response to Carbon Dioxide with Isoxia and Graded Response to Oxygen with Isocapnia

CerebralOxygenSaturation:GradedResponsetoCarbon DioxidewithIsoxiaandGradedResponsetoOxygen withIsocapnia W.AlanC.Mutch1*,SunniR.Patel2,AydaM.Shahidi2,SusithI.Kulasekara2,JosephA.Fisher3, JamesDuffin4,ChristopherHudson2 1Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada, 2Department of Ophthalmology and Vision Sciences, UniversityofToronto,Toronto,Ontario,Canada,3DepartmentofAnesthesiaandPainManagement,UniversityofToronto,Toronto,Ontario,Canada,4Departmentof Physiology,UniversityofToronto,Toronto,Ontario,Canada Abstract Background:Monitoringcerebralsaturationisincreasinglyseenasanaidtomanagementofpatientsintheoperatingroom andinneurocriticalcare.Howbesttomanipulatecerebralsaturationisnotfullyknown.Weexaminedcerebralsaturation withgradedchangesincarbondioxidetensionwhileisoxicandwithgradedchangesinoxygentensionwhileisocapnic. Methodology/PrincipalFindings:ThestudywasapprovedbytheResearchEthicsBoardoftheUniversityHealthNetwork at the University of Toronto. Thirteen studies were undertaken in healthy adults with cerebral oximetry by nearinfrared spectroscopy.End-tidalgasconcentrationsweremanipulatedusingamodel-basedprospectiveend-tidaltargetingdevice. End-tidal carbon dioxide was altered 615mmHg from baseline in 5mmHg increments with isoxia (clamped at 11064mmHg). End-tidal oxygen was changed to 300, 400, 500, 80, 60 and 50mmHg under isocapnia (376 2mmHg). Twelve studies were completed. The end-tidal carbon dioxide versus cerebral saturation fit a linear relationship (R2=0.9260.06). The end-tidal oxygen versus cerebral saturation followed log-linear behaviour and best fit a hyperbolic 2 relationship (R =0.8560.10). Cerebral saturation was maximized in isoxia at end-tidal carbon dioxide of baseline +15mmHg (7763 percent). Cerebral saturation was minimal in isocapnia at an end-tidal oxygen tension of 50mmHg (6163percent).Thecerebralsaturationduringnormoxichypocapniawasequivalenttonormocapnichypoxiaof60mmHg. Conclu