The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis
The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis
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DOI：
10.1016/j.jacc.2004.06.061
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发表时间：
2004-10-06
影响因子：
24
通讯作者：
Adatia, I
中科院分区：
文献类型：
--
作者：
Hoskote, A;Li, J;Adatia, I
结果我们研究了双向上级腔静脉吻合术（BCPA）后不同CO2压力对氧合、肺血流量（Qp）、脑血流量和体循环血流量（Qs）的影响。在机械通气患者的吸入气体中加入CO2。根据耗氧量、血管内压和氧饱和度计算Qp、Qs、PVRI和全身血管阻力指数（SVRI）。采用近红外光谱和经颅多普勒检测脑血流量（中位年龄7.1，范围2至23个月），动脉血氧分压显著升高（p < 0.005）在动脉二氧化碳分压（PaCO 2）为35、45和55 mm Hg时，从36 +/- 6 mm Hg至44 +/- 6至50 +/- 7 mm Hg，在PaCO 2为55和45与35 mm Hg相比，Qp、脑血流量和Qs显著增加，PVRI、Qp/Qs和Qp与下腔静脉血流量的比值不变，结论：我们已经证明，在BCPA后，全身氧合，Qp，Qs和脑血流量增加，SVRI降低，与35 mm Hg相比，CO2压力为45和55 mm Hg。我们认为，低氧血症后BCPA改善较高的PaCO 2和低PaCO 2或肺动脉高压可能是有害的。高碳水化合物管理策略可能允许更早进展至BCPA，这可能有助于降低功能性单心室患者的间期发病率。（美国科尔心脏病学杂志2004;44：1501-9）（C）2004年美国心脏病学会基金会。
OBJECTIVES We investigated the effects of different CO2 tensions on oxygenation, pulmonary blood flow (Qp), cerebral blood flow, and systemic blood flow (Qs) after the bidirectional superior cavopulmonary anastomosis (BCPA).BACKGROUND Hypoxemia refractory to management of a high pulmonary vascular resistance index (PVRI) may complicate recovery from the BCPA.METHODS After BCPA, CO2 was added to the inspired gas of mechanically ventilated patients. The Qp, Qs, PVRI, and systemic vascular resistance index (SVRI) were calculated from oxygen consumption, intravascular pressures, and oxygen saturations. Cerebral blood flow was estimated by near infrared spectroscopy and transcranial Doppler.RESULTS In nine patients (median age 7.1, range 2 to 23 months), arterial oxygen tension increased significantly (p < 0.005) from 36 +/- 6 mm Hg to 44 +/- 6 to 50 +/- 7 mm Hg at arterial carbon dioxide tensions (PaCO2) of 35, 45, and 55 mm Hg, respectively and decreased to 40 +/- 8 mm Hg at PaCO2 40 mm Fig. At a PaCO2 of 55 and 45 compared with 35 mm Hg, Qp, cerebral blood flow, and Qs increased significantly, PVRI, Qp/Qs, and the ratio of Qp to inferior vena caval blood flow were unchanged, but SVRl decreased.CONCLUSIONS We have demonstrated that after the BCPA, systemic oxygenation, Qp, Qs, and cerebral blood flow increased and SVRI decreased at CO2 tensions of 45 and 55 mm Hg compared with 35 mm Hg. We suggest that hypoxemia after the BCPA is ameliorated by a higher PaCO2 and that low PaCO2 or alkalosis may be detrimental. Hypercarbic management strategies may allow earlier progression to the BCPA, which may contribute to reducing the interval morbidity in patients with a functional single ventricle. (J Am Coll Cardiol 2004;44:1501-9) (C) 2004 by the American College of Cardiology Foundation.