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Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: A pilot study.

Publication ,  Journal Article
Al-Subu, A; Jooste, E; Hornik, CP; Fleming, GA; Cheifetz, IM; Ofori-Amanfo, G
Published in: Paediatr Anaesth
July 2018

BACKGROUND: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management. AIMS: The aim of this study was to assess the correlation between volume of CO2 elimination obtained by volumetric capnography and pulmonary blood flow in pediatric patients with single-ventricle physiology after stage 1 palliation as well as in patients with other cardiac lesions associated with intracardiac shunting. METHODS: This prospective cohort study included children with congenital or acquired heart disease who underwent cardiac catheterization as part of clinical care. Cardiac output, pulmonary blood flow, and volume of CO2 elimination were simultaneously collected. Spearman's rank correlation coefficients were used to assess correlation between measurements after controlling for minute ventilation. RESULTS: Thirty-five patients were enrolled and divided into 3 groups. Group 1 (n = 8) included single-ventricle patients after stage 1 palliation. Group 2 (n = 10) patients had structural heart disease with 2 ventricles and intracardiac shunting. Group 3 (n = 17) had structurally normal hearts. Among Group 1 patients, the correlation coefficients (R2 ) between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.60 (P = .02) 95% CI [0.01-0.79] and 0.29 (P = .74) 95% CI [-0.91 - 0.86], respectively. In patients with 2 ventricles associated with intracardiac shunts (Group 2), the correlation coefficients between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.86 (P = .001) 95% CI [0.53 - 0.97] and 0.73 (P = .001) 95% CI [0.29 - 0.95], respectively. Among Group 3 patients, the correlation coefficient between volume of CO2 elimination and pulmonary blood flow was 0.66 (P = .038) 95% CI [0.29 - 0.87]. CONCLUSION: Volume of CO2 elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO2 elimination may be a marker of cardiac output.

Duke Scholars

Published In

Paediatr Anaesth

DOI

EISSN

1460-9592

Publication Date

July 2018

Volume

28

Issue

7

Start / End Page

618 / 624

Location

France

Related Subject Headings

  • Pulmonary Circulation
  • Prospective Studies
  • Postoperative Care
  • Pilot Projects
  • Palliative Care
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Hemodynamics
 

Citation

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Al-Subu, A., Jooste, E., Hornik, C. P., Fleming, G. A., Cheifetz, I. M., & Ofori-Amanfo, G. (2018). Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: A pilot study. Paediatr Anaesth, 28(7), 618–624. https://doi.org/10.1111/pan.13423
Al-Subu, Awni, Edmund Jooste, Christoph P. Hornik, Gregory A. Fleming, Ira M. Cheifetz, and George Ofori-Amanfo. “Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: A pilot study.Paediatr Anaesth 28, no. 7 (July 2018): 618–24. https://doi.org/10.1111/pan.13423.
Journal cover image

Published In

Paediatr Anaesth

DOI

EISSN

1460-9592

Publication Date

July 2018

Volume

28

Issue

7

Start / End Page

618 / 624

Location

France

Related Subject Headings

  • Pulmonary Circulation
  • Prospective Studies
  • Postoperative Care
  • Pilot Projects
  • Palliative Care
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Hemodynamics