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Ann Thorac Surg 2001;72:2088-2093
© 2001 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, Medical University of South Carolina, Charleston, North Carolina, USA
b Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
* Address reprint requests to Dr Bradley, Division of Cardiothoracic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA
e-mail: bradlesm{at}musc.edu
Presented at the Poster Session of the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
Background. Mortality in the early postoperative period after the Norwood procedure remains substantial. Inspired carbon dioxide (CO2) has been suggested to improve hemodynamic status in this setting. Inspired CO2 can be delivered by one of two strategies, ie, with or without an accompanying increase in minute ventilation. The hemodynamic effects of these two strategies have not previously been studied in a controlled fashion.
Methods. Seventeen infants (median age, 9 days; range, 4 to 49 days) undergoing Norwood procedures were prospectively enrolled in this crossover study. Patients were studied while sedated, paralyzed, and mechanically ventilated 1 day to 6 days after operation. The inspired oxygen fraction was kept constant (mean value, 0.24 ± 0.01). Measurements were made at five time points: 1 = baseline; 2 = inspired CO2 with increased ventilation; 3 = baseline; 4 = inspired CO2 alone; and 5 = baseline. Mixed venous oxygen saturation was monitored using indwelling lines in the superior vena cava.
Results. Inspired CO2 with increased ventilation produced a rise in mean airway pressure with no change in arterial CO2 tension or pH. This strategy had no effect on hemodynamic status or oxygen delivery. Inspired CO2 alone produced a rise in arterial CO2 tension and a fall in arterial pH (respiratory acidosis). This strategy resulted in significant improvement in both variables of systemic oxygen delivery: mixed venous oxygen saturation increased from 48% ± 2% to 56% ± 2% (p < 0.05), and arteriovenous oxygen saturation difference decreased from 3% ± 2% to 26% ± 2% (p < 0.05).
Conclusions. Inspired CO2 after the Norwood procedure can improve oxygen delivery. This improvement occurs only if minute ventilation is kept constant. There is no improvement if minute ventilation is increased. Clinical use of inspired CO2 may be limited by the accompanying fall in pH. Differentiation of cerebral from total-body effects of inspired CO2 will require further study.
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Ann. Thorac. Surg. 2001 72: 2093-2094.
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