Skip to main content Accessibility help

Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair

  • Weizhi Zhang (a1) (a2), Siyuan Xie (a3), Ding Han (a3), Jiapeng Huang (a4), Chuan Ou-Yang (a1) and Jiakai Lu (a1)...



Ventilation-associated changes in blood carbon dioxide levels are associated with various physiological changes in infants undergoing surgery. Studies on the effects of mechanical ventilation on cerebral haemodynamics especially for infants with CHD are scarce.


This study was done to compare the changes in regional cerebral oxygen saturation and cerebral blood flow velocity when the end-tidal carbon dioxide partial pressure changed during different minute ventilation settings in infants undergoing ventricular septal defect repair.


A total of 67 patients less than 1 year old with ventricular septal defect were enrolled, and 65 patients (age: 6.7 ± 3.4 months, weight: 6.4 ± 1.5 kg) were studied. After anaesthesia induction and endotracheal intubation, the same mechanical ventilation mode (The fraction of inspired oxygen was 50%, and the inspiratory-to-expiratory ratio was 1:1.5.) was adopted. The end-tidal carbon dioxide partial pressure of 30 mmHg (T1), 35 mmHg (T2), 40 mmHg (T3), or 45 mmHg (T4) were obtained, respectively, by adjusting tidal volume and respiratory rate. Minute ventilation per kilogram was calculated by the formula: minute ventilation per kilogram = tidal volume * respiratory rate/kg. Regional cerebral oxygen saturation was monitored by real-time near-infrared spectroscopy. Cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity), pulsatility index, and resistance index were measured intermittently by transcranial Doppler. Systolic pressure, diastolic pressure, stroke volume index, and cardiac index were recorded using the pressure recording analytical method.


As the end-tidal carbon dioxide partial pressure increased from 30 to 45 mmHg, regional cerebral oxygen saturation increased significantly from 69 ± 5% to 79 ± 4% (p < 0.001). Cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity) increased linearly, while pulsatility index and resistance index decreased linearly from T1 (systolic flow velocity, 84 ± 19 cm/second; end-diastolic flow velocity, 14 ± 4 cm/second; mean flow velocity, 36 ± 10 cm/second; pulsatility index, 2.13 ± 0.59; resistance index, 0.84 ± 0.12) to T4 (systolic flow velocity, 113 ± 22 cm/second; end-diastolic flow velocity, 31 ± 6 cm/second; mean flow velocity, 58 ± 11 cm/second; pulsatility index, 1.44 ± 0.34; resistance index, 0.72 ± 0.07) (p < 0.001). There were significant differences in changes of systolic flow velocity, end-diastolic flow velocity, mean flow velocity, pulsatility index, and resistance index as the end-tidal carbon dioxide partial pressure increased from 30 to 45 mmHg between subgroups of infants ≤6 and infants >6 months, while the changes of regional cerebral oxygen saturation between subgroups were not statistically different. Regional cerebral oxygen saturation and cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity) were negatively correlated with minute ventilation per kilogram (r = −0.538, r = −0.379, r = −0.504, r = −0.505, p < 0.001). Pulsatility index and resistance index were positively related to minute ventilation per kilogram (r = 0.464, r = 0.439, p < 0.001). The diastolic pressure was significantly reduced from T1 (41 ± 7 mmHg) to T4 (37 ± 6 mmHg) (p < 0.001). There were no significant differences in systolic pressure, stroke volume index, and cardiac index with the change of end-tidal carbon dioxide partial pressure from T1 to T4 (p = 0.063, p = 0.382, p = 0.165, p > 0.05).


A relative low minute ventilation strategy increases regional cerebral oxygen saturation and cerebral blood flow, which may improve cerebral oxygenation and brain perfusion in infants undergoing ventricular septal defect repair.


Corresponding author

Author for correspondence: J. Lu and C. Ou-Yang, Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China. Tel: +86 010 64456842; Fax: +86 010 64456842; E-mails:,


Hide All

The two authors made equal contributions.



Hide All
1.Mcquillen, PS, Barkovich, AJ, Hamrick, SE, et al.Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke 2007; 38 (2 Suppl): 736741.
2.Flechet, M, Guiza, F, Vlasselaers, D, et al.Near-infrared cerebral oximetry to predict outcome after pediatric cardiac surgery: a prospective observational study. Pediatr Crit Care Med 2018; 19: 433441.
3.Scott, JP, Hoffman, GM.Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth 2014; 24: 7488.
4.Cheatham, SL, Chisolm, JL, O’brien, N.Cerebral blood flow following hybrid stage I palliation in infants with hypoplastic left heart syndrome. Pediatr Cardiol 2018; 39: 837843.
5.Cheng , HH, Wypij , D, Laussen , PC, et al.Cerebral blood flow velocity and neurodevelopmental outcome in infants undergoing surgery for congenital heart disease. Ann Thorac Surg 2014; 98: 125132.
6.Siriussawakul, A, Sharma, D, Sookplung, P, Armstead, W, Vavilala, MS.Gender differences in cerebrovascular reactivity to carbon dioxide during sevoflurane anesthesia in children: preliminary findings. Paediatr Anaesth 2011; 21: 141147.
7.Bradley, SM, Simsic, JM, Mulvihill, DM.Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg 2003; 126: 10331039.
8.Mott, AR, Alomrani, A, Tortoriello, TA, Perles, Z, East, DL, Stayer, SA.Changes in cerebral saturation profile in response to mechanical ventilation alterations in infants with bidirectional superior cavopulmonary connection. Pediatr Crit Care Med 2006; 7: 346350.
9.Maa, T, Yeates, KO, Moore-Clingenpeel, M, O’Brien, NF.Age-related carbon dioxide reactivity in children after moderate and severe traumatic brain injury. J Neurosurg Pediatr 2016; 18: 7378.
10.Greenberg, S, Murphy, G, Shear, T, et al.Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers. Can J Anaesth 2016; 63: 2430.
11.Ikeda, K, Macleod, DB, Grocott, HP, Moretti, EW, Ames, W, Vacchiano, C.The accuracy of a near-infrared spectroscopy cerebral oximetry device and its potential value for estimating jugular venous oxygen saturation. Anesth Analg 2014; 119: 13811392.
12.O’brien, NF.Reference values for cerebral blood flow velocities in critically ill, sedated children. Childs Nerv Syst 2015; 31: 22692276.
13.Favia, I, Rizza, A, Garisto, C, et al.Cardiac index assessment by the pressure recording analytical method in infants after paediatric cardiac surgery: a pilot retrospective study. Interact Cardiovasc Thorac Surg 2016; 23: 919923.
14.Ito, H, Kanno, I, Ibaraki, M, Hatazawa, J, Miura, S.Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. Cereb Blood Flow Metab 2003; 23: 665670.
15.Lee, JH, Kelly, DF, Oertel, M, et al.Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg 2001; 95: 222232.
16.Lindahl, SG, Yates, AP, Hatch, DJ.Relationship between invasive and noninvasive measurements of gas exchange in anesthetized infants and children. Anesthesiology 1987; 66: 168175.
17.Abdul-Khaliq, H, Uhlig, R, Bottcher, W, Ewert, P, Alexi-Meskishvili, V, Lange, PE. Factors influencing the change in cerebral hemodynamics in pediatric patients during and after corrective cardiac surgery of congenital heart diseases by means of full-flow cardiopulmonary bypass. Perfusion 2002; 17: 179185.
18.Nelson, DP, Andropoulos, DB, Fraser, CD, Jr.Perioperative neuroprotective strategies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2008; 2008: 4956.
19.Watzman, HM, Kurth, CD, Montenegro, LM, Rome, J, Steven, JM, Nicolson, SC.Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology 2000; 93: 947953.
20.Murkin, JM, Arango, M.Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2009; 103: i3i13.
21.Neunhoeffer, F, Sandner, K, Wiest, M, et al.Non-invasive assessment of cerebral oxygen metabolism following surgery of congenital heart disease. Interact Cardiovasc Thorac Surg 2017; 25: 96102.
22.Han, D, Li, H, Pan, S, et al.Measuring cerebral carbon dioxide reactivity with transcranial doppler and near-infrared spectroscopy in children with ventricular septal defect. J Cardiothorac Vasc Anesth 2019; 1–5.
23.An, H, Lin, W.Cerebral venous and arterial blood volumes can be estimated separately in humans using magnetic resonance imaging. Magn Reson Med 2002; 48: 583588.
24.Lee, SP, Duong, TQ, Yang, G, Iadecola, C, Kim, SG.Relative changes of cerebral arterial and venous blood volumes during increased cerebral blood flow: implications for BOLD fMresistance index. Magn Reson Med 2001; 45: 791800.
25.Urbano, J, Lopez, J, Gonzalez, R, et al.Measurement of cardiac output in children by pressure-recording analytical method. Pediatr Cardiol 2015; 36: 358364.


Related content

Powered by UNSILO

Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair

  • Weizhi Zhang (a1) (a2), Siyuan Xie (a3), Ding Han (a3), Jiapeng Huang (a4), Chuan Ou-Yang (a1) and Jiakai Lu (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.