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Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure
Summary Background: Staged reconstruction has become the preferred approach for treating neonates with hypoplastic left heart syndrome (HLHS). The haemodynamic instability of a single ventricle providing blood flow in parallel to the systemic and the pulmonary circulation, combined with the effects...
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| Published in: | Pediatric anesthesia 2003-01, Vol.13 (1), p.58-62 |
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| container_title | Pediatric anesthesia |
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| creator | Keidan, Ilan Mishaly, David Berkenstadt, Haim Perel, Azriel |
| description | Summary
Background: Staged reconstruction has become the preferred approach for treating neonates with hypoplastic left heart syndrome (HLHS). The haemodynamic instability of a single ventricle providing blood flow in parallel to the systemic and the pulmonary circulation, combined with the effects of cardiopulmonary bypass (CPB), results in precarious perioperative conditions. The two ventilatory manoeuvres commonly used for increasing pulmonary vascular resistance are (i) decreasing the fraction of inspired oxygen to |
| doi_str_mv | 10.1046/j.1460-9592.2003.00975.x |
| format | article |
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Background: Staged reconstruction has become the preferred approach for treating neonates with hypoplastic left heart syndrome (HLHS). The haemodynamic instability of a single ventricle providing blood flow in parallel to the systemic and the pulmonary circulation, combined with the effects of cardiopulmonary bypass (CPB), results in precarious perioperative conditions. The two ventilatory manoeuvres commonly used for increasing pulmonary vascular resistance are (i) decreasing the fraction of inspired oxygen to < 0.21 and (ii) adding carbon dioxide (CO2) to the ventilatory circuit. Whether molecular nitrogen (N2) or CO2 is used in these situations is a matter of physician and institutional preference. The effect of the two modalities in combination has not been studied in depth.
Methods: This prospective observational study was designed to look at the effects of adding inhaled CO2 to children with HLHS who were already on a hypoxic mixture during the immediate perioperative period.
Results: Twelve suitable neonates were enrolled in the study. Combining the two ventilatory modalities had an additive effect. The effect was more significant in the prebypass (83% of patients) compared with the postbypass period (25% of patients).
Conclusions: Low inspired oxygen and CO2 have an additive vasoconstrictive effect on the pulmonary vessels. The use of both of these ventilatory manoeuveres is less effective postoperatively compared with the prebypass period.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1046/j.1460-9592.2003.00975.x</identifier><identifier>PMID: 12535041</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Anesthesia ; Anesthesia depending on type of surgery ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; carbon dioxide ; Carbon Dioxide - therapeutic use ; Cardiac Surgical Procedures ; Humans ; hypoplastic left heart syndrome ; Hypoplastic Left Heart Syndrome - surgery ; Infant, Newborn ; low inspired oxygen ; mechanical ventilation ; Medical sciences ; Norwood procedure ; Oxygen Inhalation Therapy ; Prospective Studies ; Respiration, Artificial - methods ; single-ventricle physiology ; Thoracic and cardiovascular surgery. Cardiopulmonary bypass</subject><ispartof>Pediatric anesthesia, 2003-01, Vol.13 (1), p.58-62</ispartof><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4345-c73b26746097dc336e9e6d4c0442838be4ea9afb9293a866921ac8bf67210b663</citedby><cites>FETCH-LOGICAL-c4345-c73b26746097dc336e9e6d4c0442838be4ea9afb9293a866921ac8bf67210b663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4021,27921,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14622370$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12535041$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keidan, Ilan</creatorcontrib><creatorcontrib>Mishaly, David</creatorcontrib><creatorcontrib>Berkenstadt, Haim</creatorcontrib><creatorcontrib>Perel, Azriel</creatorcontrib><title>Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>Summary
Background: Staged reconstruction has become the preferred approach for treating neonates with hypoplastic left heart syndrome (HLHS). The haemodynamic instability of a single ventricle providing blood flow in parallel to the systemic and the pulmonary circulation, combined with the effects of cardiopulmonary bypass (CPB), results in precarious perioperative conditions. The two ventilatory manoeuvres commonly used for increasing pulmonary vascular resistance are (i) decreasing the fraction of inspired oxygen to < 0.21 and (ii) adding carbon dioxide (CO2) to the ventilatory circuit. Whether molecular nitrogen (N2) or CO2 is used in these situations is a matter of physician and institutional preference. The effect of the two modalities in combination has not been studied in depth.
Methods: This prospective observational study was designed to look at the effects of adding inhaled CO2 to children with HLHS who were already on a hypoxic mixture during the immediate perioperative period.
Results: Twelve suitable neonates were enrolled in the study. Combining the two ventilatory modalities had an additive effect. The effect was more significant in the prebypass (83% of patients) compared with the postbypass period (25% of patients).
Conclusions: Low inspired oxygen and CO2 have an additive vasoconstrictive effect on the pulmonary vessels. The use of both of these ventilatory manoeuveres is less effective postoperatively compared with the prebypass period.</description><subject>Anesthesia</subject><subject>Anesthesia depending on type of surgery</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>carbon dioxide</subject><subject>Carbon Dioxide - therapeutic use</subject><subject>Cardiac Surgical Procedures</subject><subject>Humans</subject><subject>hypoplastic left heart syndrome</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>Infant, Newborn</subject><subject>low inspired oxygen</subject><subject>mechanical ventilation</subject><subject>Medical sciences</subject><subject>Norwood procedure</subject><subject>Oxygen Inhalation Therapy</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - methods</subject><subject>single-ventricle physiology</subject><subject>Thoracic and cardiovascular surgery. Cardiopulmonary bypass</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNqNkE1v0zAYgCMEYmPwF5AvcEvwV5xY4jIqGB9Vt8OAo-U4b1aXxC52StN_P4dW23Unv5Kfxx9PliGCC4K5-LApCBc4l6WkBcWYFRjLqiymZ9n5w8bzNJOyzEvBy7PsVYwbjAmjgr7MzggtWYk5Oc_WCz801ll3h3q_R9bFrQ3QIj8d7sAh7VpkdGi8Q631k20Btbsw0wOYtXbW6B79AzfaXo82UZ0PaFwDWvmw975F2-ANJAVeZy863Ud4c1ovsp9fPt8uvubL66tvi8tlbjjjZW4q1lBRpU_IqjWMCZAgWm4w57RmdQMctNRdI6lkuhZCUqJN3XSiogQ3QrCL7P3x3HTz3x3EUQ02Guh77cDvoqqoFLySPIH1ETTBxxigU9tgBx0OimA1V1YbNcdUc0w1V1b_K6spqW9Pd-yaAdpH8ZQ1Ae9OgI6pUBe0MzY-clxQyiqcuI9Hbm97ODz5AermcpWGpOdH3cYRpgddhz9KVCyRv1dX6tft9-WPhWTqE7sH96SoFQ</recordid><startdate>200301</startdate><enddate>200301</enddate><creator>Keidan, Ilan</creator><creator>Mishaly, David</creator><creator>Berkenstadt, Haim</creator><creator>Perel, Azriel</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200301</creationdate><title>Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure</title><author>Keidan, Ilan ; Mishaly, David ; Berkenstadt, Haim ; Perel, Azriel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4345-c73b26746097dc336e9e6d4c0442838be4ea9afb9293a866921ac8bf67210b663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Anesthesia</topic><topic>Anesthesia depending on type of surgery</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>carbon dioxide</topic><topic>Carbon Dioxide - therapeutic use</topic><topic>Cardiac Surgical Procedures</topic><topic>Humans</topic><topic>hypoplastic left heart syndrome</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>Infant, Newborn</topic><topic>low inspired oxygen</topic><topic>mechanical ventilation</topic><topic>Medical sciences</topic><topic>Norwood procedure</topic><topic>Oxygen Inhalation Therapy</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - methods</topic><topic>single-ventricle physiology</topic><topic>Thoracic and cardiovascular surgery. Cardiopulmonary bypass</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keidan, Ilan</creatorcontrib><creatorcontrib>Mishaly, David</creatorcontrib><creatorcontrib>Berkenstadt, Haim</creatorcontrib><creatorcontrib>Perel, Azriel</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keidan, Ilan</au><au>Mishaly, David</au><au>Berkenstadt, Haim</au><au>Perel, Azriel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2003-01</date><risdate>2003</risdate><volume>13</volume><issue>1</issue><spage>58</spage><epage>62</epage><pages>58-62</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Summary
Background: Staged reconstruction has become the preferred approach for treating neonates with hypoplastic left heart syndrome (HLHS). The haemodynamic instability of a single ventricle providing blood flow in parallel to the systemic and the pulmonary circulation, combined with the effects of cardiopulmonary bypass (CPB), results in precarious perioperative conditions. The two ventilatory manoeuvres commonly used for increasing pulmonary vascular resistance are (i) decreasing the fraction of inspired oxygen to < 0.21 and (ii) adding carbon dioxide (CO2) to the ventilatory circuit. Whether molecular nitrogen (N2) or CO2 is used in these situations is a matter of physician and institutional preference. The effect of the two modalities in combination has not been studied in depth.
Methods: This prospective observational study was designed to look at the effects of adding inhaled CO2 to children with HLHS who were already on a hypoxic mixture during the immediate perioperative period.
Results: Twelve suitable neonates were enrolled in the study. Combining the two ventilatory modalities had an additive effect. The effect was more significant in the prebypass (83% of patients) compared with the postbypass period (25% of patients).
Conclusions: Low inspired oxygen and CO2 have an additive vasoconstrictive effect on the pulmonary vessels. The use of both of these ventilatory manoeuveres is less effective postoperatively compared with the prebypass period.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>12535041</pmid><doi>10.1046/j.1460-9592.2003.00975.x</doi><tpages>5</tpages></addata></record> |
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| subjects | Anesthesia Anesthesia depending on type of surgery Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences carbon dioxide Carbon Dioxide - therapeutic use Cardiac Surgical Procedures Humans hypoplastic left heart syndrome Hypoplastic Left Heart Syndrome - surgery Infant, Newborn low inspired oxygen mechanical ventilation Medical sciences Norwood procedure Oxygen Inhalation Therapy Prospective Studies Respiration, Artificial - methods single-ventricle physiology Thoracic and cardiovascular surgery. Cardiopulmonary bypass |
| title | Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure |
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