Abstract:
BACKGROUND:Perioperative management of patients with complete mixing of pulmonary and systemic blood centers on approximately equating pulmonary (Qp) and systemic (Qs) blood flow (Qp/Qs approximately 1). This empirically derived target is opposed by theoretical studies advocating a target Qp/Qs well below 1. We studied the cause of this persistent discrepancy. METHODS AND RESULTS:Classic theoretical studies have concentrated on maximizing 1 of many potential combination parameters of arterial oxygen content (CaO(2)) and systemic blood flow: total oxygen delivery (DO(2))=CaO(2)xQs. We defined "useful" oxygen delivery as the amount of oxygen above a notional saturation threshold (Sat(Thresh)): D(u)O(2)=carrying capacityx(SaO(2)-Sat(Thresh))xQs. Whereas DO(2) peaks at Qp/Qs ratios <1, D(u)O(2) peaks at higher Qp/Qs ratios, nearer to (or exceeding) 1. Systemic venous saturation (which mirrors tissue oxygen tension) peaks at Qp/Qs=1. CONCLUSIONS:First, the standard model of single-ventricle physiology can be reexpressed in a form allowing analysis by differential calculus, which allows broader conclusions to be drawn than does computer modeling alone. Second, the classic measure DO(2) fails to reflect the fact that proportional changes in saturation and flow are not clinically equivalent. Recognizing this asymmetry by using D(u)O(2) can give a target Qp:Qs balance that better represents clinical experience. Finally, to avoid an arbitrary choice of Sat(Thresh), systemic venous oxygen saturation (SsvO(2)) may be a useful parameter to maximize: this occurs at a Qp/Qs ratio of 1. Attempts to increase DO(2) by altering Qp/Qs away from this value will inevitably reduce SsvO(2) and therefore tissue oxygenation. Oxygen delivery is far from synonymous with tissue oxygen status.
journal_name
Circulationjournal_title
Circulationauthors
Francis DP,Willson K,Thorne SA,Davies LC,Coats AJdoi
10.1161/01.cir.100.21.2198subject
Has Abstractpub_date
1999-11-23 00:00:00pages
2198-203issue
21eissn
0009-7322issn
1524-4539journal_volume
100pub_type
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