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

  • Pilar Anton-Martin (a1), Rhucha Joshi (a2), Mounica Rao (a2), Sindhu Pandurangi (a2), Chasity Wellnitz (a3), Paul Kang (a4), John J. Nigro (a3), Daniel Velez (a3) and Brigham C. Willis (a5) (a6)...

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.

Copyright

Corresponding author

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

References

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4. West, JB. Ventilation. In: Coryell, PA (ed). Respiratory Physiology - The Essentials, 5 th edn. Williams & Wilkins, Baltimore, 1995: 1120.
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8. 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; 193:12921300
9. 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; 21:647655.
10. 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; 17:13791384.
11. 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; 26:867875.
12. Gupta, P, McDonald, R, Goyal, S, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 2014; 24:6472.
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