Oxygen transport in children after open heart surgery

Chitra Ravishankar, Anthony F. Rossi, Randall B. Griepp, Khanh H. Nguyen, Ronda P. Gross, Howard S. Seiden

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Identification of predictors of mortality after open heart surgery in children remains a challenge. By analyzing indices of oxygen transport in children after heart surgery, we hope to define parameters which may predict a benign or abnormal postoperative course, thereby identifying patients at greatest risk. Methods: Laboratory records for all patients admitted to the pediatric cardiac intensive care unit after open heart surgery from December, 1997 to July, 1998 were reviewed. Patients in whom simultaneous arterial and venous blood gases and serum lactate were measured on admission to the ICU and at 6, 12, 18 and 24 hours were included. Oxygen extraction ratio (OER), arteriovenous pH (AVPH) and pCO2 (AVCO2) gradients were calculated. The time course of these indices of oxygen transport was evaluated. Correlation between various indices was analyzed. Results: 31 children were included (mean age=0.8 years) with 29 survivors. The time course of arterial lactate, OER, AVCO2, and AVPH in survivors is plotted below. All indices exhibited a decrease from admission to 24 hours (p<0.05). AVPH decreased from admission to all time periods (p<0.05). In the 2 nonsurvivors, no parameter changed significantly from admission to 24 hours. Lactate correlated well with AVCO2 (r2=0.89, p< 0.05), AVPH(r2=0.86, p<0.05), and OER(r2=0.69, p=0.08). OER correlated well with AVCO2(r2=0.89, p<0.05) but not AVPH(r2 =0.41, p=0.2). (Figure Presented) Conclusions: The time course of indices of oxygen transport for children after open heart surgery is described. All indices significantly improve by 24 hours in survivors. Children exhibiting a deviation from this course should be evaluated carefully. All calculated indices of oxygen transport correlated well with arterial lactate levels.

Original languageEnglish
Pages (from-to)A97
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
DOIs
StatePublished - 1999

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