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The metabolic management of patients on cardiopulmonary bypass (CPB) is a complex process, involving several key biochemical and physiological parameters essential to maintaining homeostasis and reducing morbidity and mortality associated with CPB and cardiac surgery.There is movement toward goal directed perfusion (GDP), using indexed parameters such as carbon dioxide production, oxygen delivery and oxygen consumption to individualize perfusion strategies. This chapter provides an overview of the fundamental principles surrounding the metabolic management of the patient on CPB.
Capnography can provide important clues concerning the acid-base status of patients. Arterial blood gas analysis is essential to properly evaluate the acid-base status, and diagnose and treat underlying disorders. Acids and bases are constantly formed in the body as by-products of metabolism, and are carefully regulated. Buffering mechanisms include intracellular and extracellular chemical buffers, regulation of CO2 by the respiratory and central nervous systems (CNS), and control of bicarbonate by the kidney. Capillary blood samples can be used, particularly in children, to measure arterial blood gases (ABGs). Loop and thiazide diuretics can incite a metabolic alkalosis, while carbonic anhydrase inhibitors can cause a metabolic acidosis. Overdoses of drugs can produce mixed acid-base disorders, such as the combined metabolic acidosis and respiratory alkalosis from a salicylate overdose. Simple acid-base disorders involve a primary abnormality in either metabolism or respiration that produces a secondary change, or compensatory response, in the other component.
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