Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis

• Published in: Pediatric pulmonology 2002-05, Vol.33 (5), p.374-379
• Main Authors: Santamaria, Francesca, Sarnelli, Paola, Celentano, Luigi, Farina, Vincenzo, Vegnente, Angela, Mansi, Antonio, Montella, Silvia, Vajro, Pietro
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Blood Gas Monitoring, Transcutaneous; Child; Child, Preschool; Cholestasis - blood; Chronic Disease; chronic liver disease; Echocardiography; Female; gas exchange abnormalities; Gastroenterology. Liver. Pancreas. Abdomen; Hepatopulmonary Syndrome - blood; Hepatopulmonary Syndrome - physiopathology; heptopulmonary syndrome; Humans; intrapulmonary shunts; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Other diseases. Semiology; Pilot Projects; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; transcutaneous oxygen tensions
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.10088

Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O2 tension after 100% O2 (TcPO2100) breathing using a transcutaneous hyperoxia test (THT) in 11 children with chronic cholestasis and without primary cardiopulmonary disease. These patients also underwent alveolar‐arterial O2 gradient testing (AaDO2) at an inspired oxygen fraction (FiO2) of 0.21, lung scintiscan, and contrast transthoracic echocardiography (TTE). Three of them had a liver transplantation because of the downhill course of their liver disease and respiratory status. THT transcutaneous O2 tension at 21% FiO2 (TcPO221) was 75 ± 13 mmHg, and increased to 488 ± 106 mmHg after 100% O2 breathing (TcPO2100). Both mean values were not significantly different from those found in 8 age‐matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO221 and TcPO2100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO2 (54.2 mmHg; normal value,