Document Detail


Airway oximetry improves monitoring of dopamine effects in pediatric cardiac patients.
MedLine Citation:
PMID:  12793919     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Simple, preferably noninvasive measurements of cardiac output are useful in pediatric patients receiving inotropic support. Oxygen saturation in pulmonary artery (Svo(2)) gives information about oxygen delivery and demand. Many inotropic drugs influence oxygen consumption. When effects on Svo(2) are studied, after a change in inotropic drug dosage, a change in oxygen consumption needs to be considered to accurately estimate the change in cardiac output. The aim of this investigation was to study whether information on inspired to end-tidal oxygen concentration difference (Fi-eto(2)) in addition to Svo(2) would improve estimation of changes in cardiac output. DESIGN: Prospective observational study of Fi-eto(2), Svo(2), and oxygen saturation from central vein (Scvco(2)) for measurements of circulatory and metabolic effects of changes in dopamine dosage. SETTING: Intensive care unit in a children's hospital. PATIENTS: Twenty patients (age 4 days to 98 months) were studied after cardiac surgery. INTERVENTIONS: Dopamine was administered in doses of 5, 10, 0, and 5 microg x kg(-1) x min(-1), 20 mins on each level. MEASUREMENTS AND MAIN RESULTS: Cardiac output, measured with thermodilution, oxygen saturation from systemic artery (Sao(2)), Svo(2), and Scvco(2) were measured at 15 mins on each dopamine dose. Oxygen consumption was calculated by using the Fick equation. Fi-eto(2) was measured continuously with a paramagnetic oxygen analyzer. Both cardiac output and oxygen consumption were affected by changes in dopamine dosage. Relative changes in cardiac output were poorly correlated to the change in 1/Sa-vo(2) (r(2) =.54). Using Fi-eto(2) improved correlation between changes in cardiac output and changes in Fi-eto(2)/Sa-vo(2) (r(2) =.72). When Svo(2) was replaced by Scvco(2), the correlation between changes in cardiac output and changes in Fi-eto(2)/Sa-cvco(2) was only slightly altered (r(2) =.69). CONCLUSIONS: Dopamine affects oxygen consumption as well as cardiac output. The accuracy of Svo(2)-based estimations of changes in cardiac output after dopamine is enhanced if changes in Fi-eto(2) are also considered. The more easily achievable Scvco(2) gave equivalent information as Svo(2).
Authors:
Jan Bengtsson; Karl Erik Edberg; Stefan Hallhagen; Jan Peter Bengtson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  3     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2003-06-09     Completed Date:  2003-10-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  29-33     Citation Subset:  -    
Affiliation:
Department of Pediatric Anesthesia and Intensive Care, The Queen Silvia Children's Hospital, Sweden.
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