Assessment of global tissue perfusion and oxygenation in neonates and infants after open-heart surgery(dagger)

作者：Gergely Mihaly; Ablonczy Laszlo; Szekely Edgar A; Sapi Erzsebet; Gal Janos; Szatmari Andras; Szekely Andrea

来源：Interactive Cardiovascular and Thoracic Surgery, 2014, 18(4): 426-431.

DOI：10.1093/icvts/ivt537

• Haemodynamics
• Thermodilution
• Oxygen consumption
• Critical care

Monitoring and preserving adequate perfusion and oxygen balance is a primary objective of critical care. This prospective observational study aimed to assess the relationship between global haemodynamic parameters and variables reflecting tissue oxygenation during the early period following corrective cardiac surgery in neonates and infants. The postoperative time course of oxygen delivery and consumption was evaluated. As surrogate markers of oxygen balance, the central venous oxygen saturation (ScvO(2)) and venoarterial PCO2 difference (PvaCO(2)) were thoroughly investigated. %26lt;br%26gt;Thirteen children %26lt; 1 year of age who underwent open-heart surgery were prospectively enrolled. In addition to conventional postoperative monitoring, transpulmonary thermodilution (TPTD) was used to monitor cardiac output and calculate oxygen delivery and consumption. In parallel with each TPTD measurement, arterial and central venous blood gas values were recorded. Global haemodynamic parameters and oxygenation measurements were compared with weighted linear regression statistics and Pearson%26apos;s correlation coefficient. %26lt;br%26gt;Data from 145 TPTD measurements and 304 blood gas samples were recorded. The early postoperative period was characterized by a supply-dependent oxygen consumption, as demonstrated by the direct correlation between the change in oxygen delivery and consumption (r = 0.62, P %26lt; 0.001). Regarding haemodynamic parameters, none of the heart rate, mean arterial pressure or cardiac index correlated with the measured ScvO(2). However, the ScvO(2) and PvaCO(2) were found to correlate significantly (r = -0.49, P %26lt; 0.001), and both strongly related to oxygen extraction. %26lt;br%26gt;Both the ScvO(2) and PvaCO(2) are reliable and comparable parameters in following tissue oxygen balance during the early postoperative course after open-heart surgery in neonates and infants. As part of multiparameter monitoring, our data highlight the importance of regular ScvO(2) measurements and PvaCO(2) calculations in paediatric intensive care.

• 出版日期2014-4