Cerebral and Somatic Oxygen Saturations After Repair of Tetralogy of Fallot: Effects of Extubation on Regional Blood Flow
Background After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and load...
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Published in | The Annals of thoracic surgery Vol. 95; no. 2; pp. 682 - 686 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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01.02.2013
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Abstract | Background After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and loading of the respiratory muscles on the distribution of cardiac output after repair of tetralogy of Fallot. Methods In 23 consecutive patients undergoing repair of tetralogy of Fallot, standard hemodynamic variables, central venous oxygen saturations, and near infrared spectroscopy of the brain, mesenteric, and renal circulations were monitored for 30 minutes before and after extubation. Results With extubation, the systolic blood pressure increased significantly from 96 ± 11 to 106 ± 15 mm Hg ( p = 0.002) while the heart rate remained unchanged. With extubation, the central venous oxygen saturation increased significantly from 65% ± 7% to 70% ± 10% ( p = 0.003). Cerebral oxygen saturations increased significantly from 67% ± 10% to 72% ± 9% ( p = 0.0001), whereas mesenteric oxygenation fell significantly from 74% ± 15% to 72% ± 15% ( p = 0.04). Renal oxygenation was unaffected by extubation. Conclusions Cardiac output and cerebral oxygenation increased significantly during spontaneous respiration, the latter suggesting that the brain was in or approaching an oxygen supply-dependent state before extubation. Despite the increase in cardiac output, the presumed increase in respiratory pump perfusion, as well as the concurrent increase in cerebral perfusion, came at the expense of mesenteric perfusion. Renal oxygenation remained unchanged with extubation. |
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AbstractList | BACKGROUNDAfter repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and loading of the respiratory muscles on the distribution of cardiac output after repair of tetralogy of Fallot.METHODSIn 23 consecutive patients undergoing repair of tetralogy of Fallot, standard hemodynamic variables, central venous oxygen saturations, and near infrared spectroscopy of the brain, mesenteric, and renal circulations were monitored for 30 minutes before and after extubation.RESULTSWith extubation, the systolic blood pressure increased significantly from 96 ± 11 to 106 ± 15 mm Hg (p = 0.002) while the heart rate remained unchanged. With extubation, the central venous oxygen saturation increased significantly from 65% ± 7% to 70% ± 10% (p = 0.003). Cerebral oxygen saturations increased significantly from 67% ± 10% to 72% ± 9% (p = 0.0001), whereas mesenteric oxygenation fell significantly from 74% ± 15% to 72% ± 15% (p = 0.04). Renal oxygenation was unaffected by extubation.CONCLUSIONSCardiac output and cerebral oxygenation increased significantly during spontaneous respiration, the latter suggesting that the brain was in or approaching an oxygen supply-dependent state before extubation. Despite the increase in cardiac output, the presumed increase in respiratory pump perfusion, as well as the concurrent increase in cerebral perfusion, came at the expense of mesenteric perfusion. Renal oxygenation remained unchanged with extubation. After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and loading of the respiratory muscles on the distribution of cardiac output after repair of tetralogy of Fallot. In 23 consecutive patients undergoing repair of tetralogy of Fallot, standard hemodynamic variables, central venous oxygen saturations, and near infrared spectroscopy of the brain, mesenteric, and renal circulations were monitored for 30 minutes before and after extubation. With extubation, the systolic blood pressure increased significantly from 96 ± 11 to 106 ± 15 mm Hg (p = 0.002) while the heart rate remained unchanged. With extubation, the central venous oxygen saturation increased significantly from 65% ± 7% to 70% ± 10% (p = 0.003). Cerebral oxygen saturations increased significantly from 67% ± 10% to 72% ± 9% (p = 0.0001), whereas mesenteric oxygenation fell significantly from 74% ± 15% to 72% ± 15% (p = 0.04). Renal oxygenation was unaffected by extubation. Cardiac output and cerebral oxygenation increased significantly during spontaneous respiration, the latter suggesting that the brain was in or approaching an oxygen supply-dependent state before extubation. Despite the increase in cardiac output, the presumed increase in respiratory pump perfusion, as well as the concurrent increase in cerebral perfusion, came at the expense of mesenteric perfusion. Renal oxygenation remained unchanged with extubation. Background After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure ventilation has been shown to improve cardiac output in these patients. What has not been evaluated is the effect of extubation and loading of the respiratory muscles on the distribution of cardiac output after repair of tetralogy of Fallot. Methods In 23 consecutive patients undergoing repair of tetralogy of Fallot, standard hemodynamic variables, central venous oxygen saturations, and near infrared spectroscopy of the brain, mesenteric, and renal circulations were monitored for 30 minutes before and after extubation. Results With extubation, the systolic blood pressure increased significantly from 96 ± 11 to 106 ± 15 mm Hg ( p = 0.002) while the heart rate remained unchanged. With extubation, the central venous oxygen saturation increased significantly from 65% ± 7% to 70% ± 10% ( p = 0.003). Cerebral oxygen saturations increased significantly from 67% ± 10% to 72% ± 9% ( p = 0.0001), whereas mesenteric oxygenation fell significantly from 74% ± 15% to 72% ± 15% ( p = 0.04). Renal oxygenation was unaffected by extubation. Conclusions Cardiac output and cerebral oxygenation increased significantly during spontaneous respiration, the latter suggesting that the brain was in or approaching an oxygen supply-dependent state before extubation. Despite the increase in cardiac output, the presumed increase in respiratory pump perfusion, as well as the concurrent increase in cerebral perfusion, came at the expense of mesenteric perfusion. Renal oxygenation remained unchanged with extubation. |
Author | Anas, Nick G Adams, Gerald J., EdD PStat Checchia, Paul A., MD Bleiweis, Mark S., MD Penny, Daniel J., MD, PhD Bronicki, Ronald A., MD Shekerdemian, Lara S., MD |
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Cites_doi | 10.1016/S0003-4975(10)61078-8 10.1097/00000539-200003000-00012 10.1111/j.1747-0803.2010.00445.x 10.1172/JCI111065 10.1016/S0022-5223(19)38413-2 10.1097/00000542-199510000-00013 10.1016/S0735-1097(98)00598-1 10.1016/S0022-5223(19)35338-3 10.1111/j.1748-1716.1961.tb02147.x 10.1097/00004647-200203000-00011 10.1111/j.1749-6632.1994.tb55706.x 10.1161/01.CIR.100.14.1540 10.1097/PCC.0b013e31819887f0 10.1097/CCM.0b013e318228297a 10.1016/S0749-0704(05)70296-7 |
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jugular bulb catheters publication-title: Crit Care Clin doi: 10.1016/S0749-0704(05)70296-7 contributor: fullname: Feldman |
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Snippet | Background After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure.... After repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure. Negative-pressure... BACKGROUNDAfter repair of tetralogy of Fallot, some patients experience a low cardiac output state owing to right ventricular diastolic failure.... |
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SubjectTerms | Airway Extubation Brain - metabolism Cardiac Output Cardiothoracic Surgery Humans Infant Oxygen - metabolism Postoperative Period Prospective Studies Regional Blood Flow Surgery Tetralogy of Fallot - surgery |
Title | Cerebral and Somatic Oxygen Saturations After Repair of Tetralogy of Fallot: Effects of Extubation on Regional Blood Flow |
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