ARTERIAL OXYGEN SATURATION (SaO2) DOES NOT ACCURATELY PREDICT ADEQUACY OF SYSTEMIC OXYGEN DELIVERY IN NEONATES FOLLOWING NORWOOD PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME

1998 ◽  
Vol 89 (Supplement) ◽  
pp. 1268A ◽  
Author(s):  
J M Kampine ◽  
J S Tweddell ◽  
G M Hoffman
Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Sarah Tabbutt ◽  
Chandra Ramamoorthy ◽  
Lisa M. Montenegro ◽  
Suzanne M. Durning ◽  
C. Dean Kurth ◽  
...  

Background Management strategies for preoperative infants with hypoplastic left heart syndrome (HLHS) include increased inspired nitrogen (hypoxia) and increased inspired carbon dioxide (hypercarbia). There are no studies directly comparing these 2 therapies in humans. This study compares the impact of hypoxia versus hypercarbia on oxygen delivery, under conditions of fixed minute ventilation. Methods and Results Ten anesthetized and paralyzed preoperative infants with HLHS were evaluated in a prospective, randomized, crossover trial comparing hypoxia (17% F io 2 ) with hypercarbia (2.7% F ico 2 ). Each patient was treated in a random order (10 minutes per condition) with a recovery period (15 to 20 minutes) in room air. Arterial (Sa o 2 ) and superior vena caval (Sv o 2 ) co-oximetry and cerebral oxygen saturation (Sc o 2 ) measurements were made at the end of each condition and recovery period. Sc o 2 was measured by near infrared spectroscopy. Hypoxia significantly decreased both Sa o 2 (−5.2±1.1%, P =0.0014) and Sv o 2 (−5.6±1.7%, P =0.009) compared with baseline, but arteriovenous oxygen saturation (AV o 2 ) difference (Sa o 2 −Sv o 2 ) and Sc o 2 remained unchanged. Hypercarbia decreased Sa o 2 (−2.6±0.6%, P =0.002) compared with baseline but increased both Sc o 2 (9.6±1.8%, P =0.0001) and Sv o 2 (6±2.2%, P =0.022) and narrowed the AV o 2 difference (−8.5±2.3%, P =0.005). Both hypoxia and hypercarbia decreased the balance between pulmonary and systemic blood flow (Qp:Qs) compared with baseline. Conclusions In preoperative infants with HLHS, under conditions of anesthesia and paralysis, although Qp:Qs falls in both conditions, oxygen delivery is unchanged during hypoxia and increased during hypercarbia. These data cannot differentiate cerebral from systemic oxygen delivery.


2011 ◽  
Vol 21 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Yahya Yildiz ◽  
Ahmet Kirbas ◽  
Onur Gurer ◽  
Mehmet S. Bilal

AbstractObjectiveThis study aimed to describe the pre-operative and operative findings, as well as the post-operative haemodynamics of patients operated on for hypoplastic left heart. The findings of patients who survived or did not survive were also compared to anticipate the risk factors for mortality.MethodsWe retrospectively reviewed the anaesthetic and intensive care records of 11 (seven male and four female) patients who underwent a modified Norwood operation as neonates. There were eight patients who survived, while three did not survive after the operation. Haemodynamics, oxygenation, and medications of patients were recorded for the pre-operative and post-operative conditions for 2 days, and compared between groups of patients who survived and those who did not.ResultsThe normalised modified Blalock–Taussig shunt area was 3.28, 0.57 square millimetres per kilogram (mean, standard deviation) for the group of patients who survived and 3.55, 1.4 square millimetres per kilogram for the group of patients who did not survive (p = 0.51). The group of patients who survived had a significantly larger normalised aortic annulus area (3.3, 0.89 square millimetres per kilogram versus 1.68, 0.21 square millimetres per kilogram, p = 0.01), lower median age (5.57 (3–8) days versus 46.67 (4–90) days, p = 0.02), and lower weight (2.95, 0.46 kilograms versus 3.85, 0.56 kilograms, p = 0.03) than the group of patients who did not survive. Furthermore, the group of patients who did not survive had a significantly worse pre-operative condition, lower systemic venous and arterial oxygen saturation, and need for a high dose of drugs in the pre-operative and post-operative periods (p was less than 0.05 for each variable).ConclusionThe pre-operative, operative, and post-operative findings may be related to mortality early after the modified Norwood operation for hypoplastic left heart syndrome.


2007 ◽  
Vol 84 (4) ◽  
pp. 1301-1311 ◽  
Author(s):  
James S. Tweddell ◽  
Nancy S. Ghanayem ◽  
Kathleen A. Mussatto ◽  
Michael E. Mitchell ◽  
Luke J. Lamers ◽  
...  

2020 ◽  
Vol 37 (S 02) ◽  
pp. S54-S56
Author(s):  
Italo Francesco Gatelli ◽  
Ottavio Vitelli ◽  
Gaia Chiesa ◽  
Francesca De Rienzo ◽  
Stefano Martinelli

Objective This study aimed to describe the first two cases of electrical cardiometry applied to newborn with hypoplastic left heart syndrome for hemodynamical assessment in the first days of life before surgical correction and see if this can help decision making process in these patients. Study Design We describe two case series of two full-term newborn with hypoplastic left heart syndrome in the Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, between December 2019 and January 2020. Results Case 1 was persistently hemodynamically stable with prostaglandin E1 infusion at 0.01 mcg/kg/min, showing good capillary refill time, good diuresis, no difference between pre- and postductal values of oxygen saturation or blood pressure. Electrical cardiometry monitoring constantly showed cardiac output values higher than 300 mL/kg/min. Case 2 showed poor clinical condition needing prostaglandin E1 infusion up to 0.05 mcg/kg/min, intubation and septostomy associated with low cardiac output around 190 mL/kg/min. Once cardiac output has begun to rise and reached values constantly over 300 mL/kg/min, clinical condition improved with amelioration in oxygen saturation, diuresis, blood pressure, and blood gas analysis values. She was then extubated and finally clinically stable until surgery with minimal infusion of prostaglandin E1 at 0.01 mcg/kg/min. Conclusion This case highlights how hemodynamic information provided by electrical cardiometry can be used to supplement the combined data from all monitors and the clinical situation to guide therapy in these newborns waiting surgery. Key Points


2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Michael H. White ◽  
Michael Kelleman ◽  
Robert F. Sidonio ◽  
Lazaros Kochilas ◽  
Kavita N. Patel

Background Thrombosis is common in infants undergoing staged surgeries for single‐ventricle congenital heart disease. The reported incidence and timing of thrombosis varies widely, making it difficult to understand the burden of thrombosis and develop approaches for prevention. We aimed to determine the timing and cumulative incidence of thrombosis following the stage I Norwood procedure and identify clinical characteristics associated with thrombosis. Methods and Results We analyzed data from the Pediatric Heart Network Single Ventricle Reconstruction trial from 2005 to 2009 and identified infants with first‐time thrombotic events. In 549 infants, the cumulative incidence of thrombosis was 21.2% (n=57) from stage I through stage II. Most events occurred during stage I (n=35/57, 65%), with a median time to thrombosis of 15 days. We used a Cox proportional hazards model to estimate the association of clinical variables with thrombosis. After adjusting for baseline variables, boys had a higher hazard of thrombosis (adjusted hazard ratio [HR], 2.69; 95% CI, 1.44–5.05; P =0.002), non–hypoplastic left heart syndrome cardiac anatomy was associated with a higher early hazard of thrombosis (adjusted HR, 3.93; 95% CI, 1.89–8.17; P <0.001), and longer cardiopulmonary bypass time was also associated with thrombosis (per 10‐minute increase, adjusted HR, 1.07; 95% CI, 1.01–1.12; P =0.02). Lower oxygen saturation after the Norwood procedure increased the hazard for thrombosis in the unadjusted model (HR, 1.08; 95% CI, 1.02–1.14; P =0.011). Conclusions Thrombosis affects 1 in 5 infants through Stage II discharge, with most events occurring during stage I. Male sex, non–hypoplastic left heart syndrome anatomy, longer cardiopulmonary bypass time, and lower stage I oxygen saturation were associated with thrombosis.


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