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Dead space fractions in neonates following first-stage palliation for hypoplastic left heart syndrome

Published online by Cambridge University Press:  17 April 2019

Pilar Anton-Martin Open the ORCID record for Pilar Anton-Martin [Opens in a new window] ,
Rhucha Joshi ,
Mounica Rao ,
Sindhu Pandurangi ,
Chasity Wellnitz ,
Paul Kang ,
John J. Nigro ,
Daniel Velez  and
Brigham C. Willis
Pilar Anton-Martin*
Affiliation:
Department of Medical Education, Phoenix Children’s Hospital, Phoenix, Arizona, USA
Rhucha Joshi
Affiliation:
Department of Medical Education, University of Arizona College of Medicine, Phoenix, Arizona, USA
Mounica Rao
Affiliation:
Department of Medical Education, University of Arizona College of Medicine, Phoenix, Arizona, USA
Sindhu Pandurangi
Affiliation:
Department of Medical Education, University of Arizona College of Medicine, Phoenix, Arizona, USA
Chasity Wellnitz
Affiliation:
Department of Cardiothoracic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
Paul Kang
Affiliation:
Department of Epidemiology and Biostatistics, University of Arizona College of Medicine, Phoenix, Arizona, USA
John J. Nigro
Affiliation:
Department of Cardiothoracic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
Daniel Velez
Affiliation:
Department of Cardiothoracic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
Brigham C. Willis
Affiliation:
Department of Medical Education, Division of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA University of Arizona College of Medicine, Phoenix, Arizona, USA
*
Author for correspondence: Pilar Anton-Martin, MD, PhD, Department of Medical Education, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, USA. Tel: (602) 933-0768; Fax: (602) 933-2321; E-mail: pantonmartin@phoenixchildrens.com
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Abstract

Purpose:

(1) To characterise changes in dead space fraction during the first 120 post-operative hours in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome, including hybrid procedure; (2) to document whether dead space fraction varied by shunt type (Blalock–Taussig shunt and Sano) and hybrid procedure; and (3) to determine the association between dead space fraction and outcomes.

Methods:

Retrospective chart review in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome in a cardiac intensive care unit over a consecutive 30-month period. A linear mixed model was used to determine the differences in dead space over time. Multivariable linear regression and a multivariable linear mixed model were used to assess the association between dead space and outcomes at different time points and over time, respectively.

Results:

Thirty-four neonates received either a Blalock–Taussig shunt (20.5%), Sano shunt (59%), or hybrid procedure (20.5%). Hospital mortality was 8.8%. Dead space fractions in patients undergoing the hybrid procedure were significantly lower on day 1 (p = 0.01) and day 2 (p = 0.02) and increased over time. A dead space fraction >0.6 on post-operative days 3–5 was significantly associated with decreased duration of mechanical ventilation in all surgical groups (p < 0.001).

Conclusions:

Dead space fraction >0.6 on post-operative days 3–5 was associated with lower duration of mechanical ventilation in all surgical groups. A more comprehensive, prospective assessment of dead space in this delicate patient population would likely be beneficial in improving outcomes.

Keywords

Hypoplastic left heart syndromeNorwood procedureBlalock–Taussig shuntSano shunthybrid proceduredead space
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 481 - 487
Copyright
© Cambridge University Press 2019 

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References

Feinstein, JA, Benson, DW, Dubin, AM, et al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59: S1–S42.CrossRefGoogle ScholarPubMed
Shakti, D, McElhinney, DB, Gauvreau, K, et al. Pulmonary deadspace and postoperative outcomes in neonates undergoing stage 1 palliation operation for single ventricle heart disease. Pediatr Crit Care Med 2014; 15: 728–734.CrossRefGoogle ScholarPubMed
Devor, RL, Kang, P, Wellnitz, C, et al. Pulmonary dead space fraction and extubation success in children after cardiac surgery. Pediatr Crit Care Med 2018, 19:301–309.CrossRefGoogle ScholarPubMed
West, JB. Ventilation. In: Coryell, PA (ed). Respiratory Physiology - The Essentials, 5 th edn. Williams & Wilkins, Baltimore, 1995: 11–20.Google Scholar
Ong, T, Stuart-Killion, RB, Daniel, BM, et al. Higher pulmonary dead space may predict prolonged mechanical ventilation after cardiac surgery. Pediatr Pulmonol 2009, 44:457–463.CrossRefGoogle ScholarPubMed
Székely, A, Sápi, E, Király, L, et al. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth 2006; 16:1166–1175.Google ScholarPubMed
Dixon, B, Campbell, DJ, Santamaria, JD. Elevated pulmonary dead space and coagulation abnormalities suggest lung microvascular thrombosis in patients undergoing cardiac surgery. Intensive Care Med 2008; 34:1216–1223.CrossRefGoogle ScholarPubMed
Kee, K, Stuart-Andrews, C, Ellis, MJ, et al. Increased dead space ventilation mediates reduced exercise capacity in systolic heart failure. Am J Respir Crit Care Med 2016; 193:1292–1300 CrossRefGoogle ScholarPubMed
Taylor, BJ, Smetana, MR, Frantz, RP, et al. Submaximal exercise pulmonary gas exchange in left heart disease patients with different forms of pulmonary hypertension. J Card Fail 2015; 21:647–655.CrossRefGoogle ScholarPubMed
Bugnitz, CJ, Miao, Y, Berger, GE, et al. Changes in right ventricular function in neonates with hypoplastic left heart syndrome before and after the hybrid procedure. Eur Heart J Cardiovasc Imaging 2016; 17:1379–1384.CrossRefGoogle ScholarPubMed
Kobayashi, D, Natarajan, G, Turner, DR, et al. Effect of Hybrid stage 1 procedure on ventricular function in infants with hypoplastic left heart syndrome. Cardiol Young 2016; 26:867–875.CrossRefGoogle ScholarPubMed
Gupta, P, McDonald, R, Goyal, S, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 2014; 24:64–72.CrossRefGoogle ScholarPubMed
Wernovsky, G, Kuijpers, M, Van Rossem, MC, et al. Postoperative course in the cardiac intensive care unit following the first stage of Norwood reconstruction. Cardiol Young 2007; 17:652–665.CrossRefGoogle ScholarPubMed
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