Extrapulmonary Influences on A-aD02 1.0 Following Cardiopulmonary Bypass

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Abstract
Pulmonary insufficiency is one of many diagnostic and therapeutic challenges posed by postoperative or traumatically injured patients. The alveolar-arterial O2 tension gradient calculated during inhalation of 100% O2 (A-aDO21.0) is used widely for assessment of pulmonary dysfunction. Changes in A-aDO21.0 are used to dictate O2 therapy, initiation or withdrawal of mechanical ventilatory support, application of positive end-expiratory pressure (PEEP), administration of diuretics and colloid therapy and initiation of extracorporeal membrane oxygenation. Changes in A-aDO21.0 following therapeutic interventions or clinical occurrences that could alter any of the other variables affecting A-aDO21.0 should not be attributed to intrapulmonary shunting unless all of the other variables were measured. Investigations that equate changes in arterial oxygenation with improvement of deterioration of pulmonary function must be interpreted with caution and in context with other factors that may modify these values.

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