Document Detail

Hemodynamics and cerebral oxygenation following repair of tetralogy of Fallot: the effects of converting from positive pressure ventilation to spontaneous breathing.
MedLine Citation:
PMID:  21087425     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Following corrective surgery for tetralogy of Fallot (TOF), approximately one-third of these patients develop low cardiac output (CO) due to right ventricular (RV) diastolic heart failure. Extubation is beneficial in these patients because the fall in intrathoracic pressure that occurs with conversion from positive pressure breathing to spontaneous breathing improves venous return, RV filling and CO. We hypothesized that if CO were to increase but remain limited following extubation, the obligatory increase in perfusion to the respiratory pump that occurs with loading of the respiratory musculature may occur at the expense of other vital organs, including the brain.
MATERIALS AND METHODS: We conducted a retrospective analysis of all patients undergoing repair of TOF and monitoring of cerebral oxygenation using near infrared spectroscopy. We evaluated the following parameters two hours prior to and following extubation: mean and systolic arterial blood pressure (MBP, SBP), right atrial pressure (RAP), heart rate (HR) and cerebral oxygenation.
RESULTS: The study included 22 patients. With extubation, MBP and SBP increased significantly from 67.3 ± 6.5 to 71.1 ± 8.4 mm Hg (P= 0.004) and from 87.2 ± 8.6 to 95.9 ± 10.9 mm Hg (P= 0.001), respectively, while the HR remained unchanged (145 vs. 146 bpm). The RAP remained unchanged following extubation (11.9 vs. 12.0 mm Hg). Following extubation, cerebral oxygen saturations increased significantly from 68.5 ± 8.4 to 74.2 ± 7.9% (P < 0.0001). Cerebral oxygen saturations increased by ≥5% in 11 of 22 patients and by ≥10% in 5 of 22 patients.
CONCLUSION: We conclude that converting from positive pressure ventilation to spontaneous negative pressure breathing following repair of TOF significantly improves arterial blood pressure and cerebral oxygenation.
Ronald A Bronicki; Marilyn Herrera; Richard Mink; Michele Domico; Dawn Tucker; Anthony C Chang; Nick G Anas
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Congenital heart disease     Volume:  5     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-11-22     Completed Date:  2011-03-04     Revised Date:  2011-05-05    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  416-21     Citation Subset:  IM    
Division of Pediatric Critical Care Medicine, Children's Hospital of Orange County, Orange, California 92868, USA.
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MeSH Terms
Blood Pressure
Brain / blood supply,  metabolism*
Cardiac Output
Cardiac Output, Low / etiology,  physiopathology,  therapy*
Cardiac Surgical Procedures* / adverse effects
Cardiovascular Agents / therapeutic use
Cerebrovascular Circulation
Child, Preschool
Fluid Therapy
Heart Rate
Monitoring, Physiologic / methods
Oxygen Consumption*
Positive-Pressure Respiration*
Respiratory Mechanics
Retrospective Studies
Spectroscopy, Near-Infrared
Tetralogy of Fallot / metabolism,  physiopathology,  surgery*
Time Factors
Treatment Outcome
Ventilator Weaning*
Reg. No./Substance:
0/Cardiovascular Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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