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3 results

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

  • Pilar Anton-Martin, Rhucha Joshi, Mounica Rao, Sindhu Pandurangi, Chasity Wellnitz, Paul Kang, John J. Nigro, Daniel Velez, Brigham C. Willis
  • Journal:
    Cardiology in the Young / Volume 29 / Issue 4 / April 2019
    Published online by Cambridge University Press:
    17 April 2019, pp. 481-487
  • 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.

  • Chapter 10 - Anesthesia for mediastinoscopy and mediastinal surgery

  • from Section 2 - Anesthesia for operative procedures
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 68-74

  • Summary

    The primary task of the lungs is respiration. Respiration is the exchange of gases between an organism and its environment with the utilization of O2 and production of CO2. The most important physiological measure is the compliance of the intact respiratory system. The movement of O2 and CO2 in and out of the capillaries both in the lungs and in the peripheral tissues depends on gas diffusion. Positive pressure ventilation results in most of the ventilation being directed into the upper rather than the lower lung. The blood flow gradient due to gravity favors the dependent lung during one-lung ventilation (OLV). If the non-dependent lung is not ventilated any blood flow to it becomes shunt flow. This results in a larger alveolar-to-arterial oxygen tension difference with a lower PaO2 for a given oxygen concentration under identical circumstances, when compared to two-lung ventilation in the same position.

  • 7 - Carbon dioxide balance

  • Edited by Iain Mackenzie
  • Book:
    Core Topics in Mechanical Ventilation
    Published online:
    14 October 2009
    Print publication:
    30 October 2008, pp 142-159

  • Summary

    Carbon dioxide is excreted by the lungs. Carbon dioxide production is based on metabolic rate and the substrates that are being utilized to drive the Kreb's cycle. Factors that influence pulmonary elimination of carbon dioxide include the volume of dead space, tidal volume, respiratory frequency and positive end-expiratory pressure (PEEP). The balance between arterial and venous carbon dioxide is based upon cardiac output. Hypocapnia can be controlled relatively through adjustment of ventilator settings to reduce minute ventilation in the sedated patient. The effects of hypercapnia and the associated acidaemia may be mitigated through the use of buffering agents. Traditionally, extracorporeal gas exchange (ECGE) has been utilized in patients only as a rescue therapy. In practice, clinicians adopt a technique somewhere between optimal carbon dioxide clearance and more liberal clearance targets, based on assessment of the severity of lung disease and the risks and benefits of ventilatory manipulations or associated interventions.