人生不过一片浮云CO2andanestheticgasconcentrationsinthe.PPTVIP

人生不過一片浮雲 CO2 and anesthetic gas concentrations in the exhaust port of the membrane oxygenator ETCO2 and CPB: ETCO2不是目標 (circuit) PaCO2才是目標 (blood) From PaCO2, To PACO2 (alveolar), To End-tidal CO2 (Circuit) 之間一直存在有很大的Gaps Bicarbonate buffer system: Arterial blood gas analysis: 干擾因素: From PaCO2 (blood) to PACO2 (alveolar) Lung condition, 主要是gas exchange Ventilation-perfusion (mis)match From PACO2 (alveolar) To End-tidal CO2 (Circuit) Airway condition Ventilation amount From PaCO2 (blood) To PACO2 (alveolar): From PACO2 (alveolar) To End-tidal CO2 (Circuit): O2 is a drug: Drug overdosage Oxygen toxicity Never pure O2 through CPB SIRS Ischemic reperfusion injury Radical oxygen species CO2 is a drug, too: Hyperventilation: CO2 washout IICP drop Cerebral vasoconstriction, ischemia CO2 is a drug, too: Hyperventilation: CO2 washout Hypoventilation: CO2 retention Cerebral vasodilatation, brain edema Permissive hypercapnia (ARDS) PAH Alkalosis缺點: 改變pH值, 會影響體內Enzymes作用, 包括全身的生理作用 Alkalosis造成呼吸抑制, 因為CO2降低, Respiratory drive 降低 O2-Hb dissociation curve: Shift to the left, Hb更不容易釋放O2 抑制HPV＝Hypoxic pulmonary vasoconstriction, VQ mismatch更加嚴重 抑制NMB的作用, 容易發生Patient movement Oxyhemoglobin dissociation curve: