Abstract:
BACKGROUND:Hemodynamic stability after Norwood palliation often requires manipulation of pulmonary vascular resistance to alter the pulmonary-to-systemic blood flow ratio (Qp:Qs). Qp:Qs is often estimated from arterial saturation (SaO2), a practice based on 2 untested assumptions: constant systemic arteriovenous O2 difference and normal pulmonary venous saturation. METHODS AND RESULTS:In 12 patients early (=3 days) after Norwood palliation, simultaneous arterial, superior vena caval (SsvcO2), and pulmonary venous (SpvO2) oximetry was used to test whether SaO2 accurately predicts Qp:Qs. Stepwise multiple regression assessed the contributions of SaO2, SsvcO2, and SpvO2 to Qp:Qs determination. SaO2 correlated weakly with Qp:Qs (R2=0.08, P<0.05). Inclusion of SsvcO2 and SpvO2 improved Qp:Qs prediction accuracy. Pulmonary venous desaturation (SpvO2 <95%) was observed frequently (30%), especially at FiO2 =0.21, but normalized with higher FiO2 or PEEP in all patients. In 6 patients, FiO2 was increased incrementally from 0.17 to 0.50 to determine whether this was an effective means to manipulate Qp:Qs. Qp:Qs failed to change predictably with increased FiO2. In 5 of 6 patients, however, higher SpvO2 and SaO2 enhanced systemic oxygen delivery, as demonstrated by improvement in oxygen extraction. CONCLUSIONS:SaO2 correlated poorly with Qp:Qs because of variability in SsvcO2 and SpvO2. A novel observation was that pulmonary venous desaturation occurred frequently early after Norwood palliation but normalized with higher FiO2 or PEEP. Because unrecognized pulmonary venous desaturation confounds p:s assessment and compromises SaO2 and oxygen delivery, judicious use of inspired oxygen and PEEP may be beneficial in selected patients early after Norwood palliation.
journal_name
Circulationjournal_title
Circulationauthors
Taeed R,Schwartz SM,Pearl JM,Raake JL,Beekman RH 3rd,Manning PB,Nelson DPdoi
10.1161/01.cir.103.22.2699subject
Has Abstractpub_date
2001-06-05 00:00:00pages
2699-704issue
22eissn
0009-7322issn
1524-4539journal_volume
103pub_type
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