Abstract
During the last decade as increasing numbers of patients with severe cardio-pulmonary disorders have become candidates for anesthesia and surgery, it has become apparent that arterial hypoxemia may accompany seemingly adequate pulmonary ventilation with atmospheres containing high inspired concentrations of oxygen even in patients with normal pulmonary function and no impairment of diffusion. A recent review by Markello1 states that ventilationperfusion (VA/Q) mismatch (in the absence of true anatomical shunt) is most often the underlying cause of this hypoxemia. Determinations of A-aDO2 and calculation of dead space to tidal volume ratios (VD/VT), while clearly demonstrating this shunt-like effect, give little information of therapeutic value to help in obtaining a better VA/Q match. The anesthesiologist daily faces the necessity of providing a cyclic flow of alveolar gas distributed as evenly as possible throughout the lung without causing reduction and maldistribution of already impaired perfusion in situations where low cardiac output exists, as is the case in many of the patients undergoing cardiac surgery.
Published Version
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