The hazardous effects of alveolar hypocapnia on lung mechanics during weaning from cardiopulmonary bypass

The bronchoconstrictive effects of alveolar hypocapnia during weaning from cardiopulmonary bypass (CPB) were investigated in patients undergoing elect ive coronary artery revascularization. Thirty patients were randomly assign ed into two equal groups. In both groups, mechanical ventilation was initia ted for 3 min prior to weaning from CPB with the venous pressure low. This kept the pulmonary vascular bed empty, resulting in alveolar hypocapnia (ET CO2 < 2 kPa). Peak airway pressure (P-peak) and plateau pressures (P-platea u) were recorded. In group 1, 5% CO2 was added to the inspiratory gas mixtu re and the ETCO2 allowed to rise (ETCO2 > 3.3 kPa). The ventilation pressur e measurements were recorded again after 3 min stabilization. In group 2,th e venous pressure was increased to allow the pulmonary venous bed to fill a nd the ventilation pressures recorded after a 3 min period of stabilization . In group 1, the ventilatory pressures dropped significantly (p < 0.001) whe n the alveolar hypocapnia was reversed with added CO2 (P-peak 19.71 +/- 5.7 to 12.31 +/- 2.8 cmH(2)O and P-plateau 13.25 +/- 3.28 to 9.15 +/- 2.23 cmH (2)O). In group 2, a similar effect was achieved by allowing filling of the pulmonary vascular bed (P-peak 17.46 +/- 4.72 to 11.92 +/- 3.03 cmH(2)O an d P-plateau 13.93 +/- 4.10 to 9.37 +/- 3.00 cmH(2)O). These results suggest that filling the pulmonary vascular bed prior to init ialing ventilation, when weaning from CPB, prevents the otherwise deleterio us effects of alveolar hypocapnia, resulting in raised bronchomotor tonus a nd raised airway pressures.