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Oxygen transport in critically ill infants after congenital heart operations
A F Rossi1, H S Seiden, R P Gross
1Department of Pediatrics, The Mount Sinai Medical Center, New York, New York 10029, USA.
Insights
Infants undergoing cardiac surgery show altered oxygen transport at 6 hours post-op, with higher oxygen extraction ratios indicating increased mortality risk. This finding aids in predicting outcomes for pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Physiology
Background:
- Oxygen transport is crucial for balancing delivery and demand.
- Oxygen transport in infants post-congenital cardiac surgery is not well-documented.
- Understanding these dynamics can improve patient outcomes.
Purpose of the Study:
- To examine oxygen transport variables in infants undergoing congenital cardiac operations.
- To identify differences between survivors and nonsurvivors.
- To find variables predictive of patient outcome.
Main Methods:
- Retrospective review of hospital records for infants in a pediatric cardiac intensive care unit (ICU).
- Inclusion criteria: simultaneous arterial blood gas and systemic venous oxygen saturation measurements at admission, 6, and 24 hours.
- Analysis included arterial pH, base excess, arteriovenous oxygen saturation difference, and oxygen extraction ratio.
Main Results:
- Forty-nine infants were studied; 39 survived.
- No significant differences in parameters between survivors and nonsurvivors at admission or 24 hours.
- At 6 hours, nonsurvivors showed significantly lower arterial pH, lower base excess, higher arteriovenous oxygen saturation difference, and higher oxygen extraction ratio compared to survivors.
Conclusions:
- Infants who do not survive cardiac operations exhibit significant oxygen transport derangements 6 hours post-ICU admission.
- An oxygen extraction ratio greater than 0.5 at 6 hours is a strong indicator of highest risk for mortality.
- These findings highlight critical time points for monitoring and intervention in pediatric cardiac surgery patients.
Background:
Oxygen transport variables reflect the balance of oxygen delivery and demand. Because oxygen transport in infants undergoing congenital cardiac operations is not well described, we examined oxygen transport in such patients. Differences in oxygen transport between survivors and nonsurvivors and variables that might be predictive of outcome were sought.
Methods:
We reviewed hospital records of infants admitted to the pediatric cardiac intensive care unit in our institution from January 1996 through April 1997. Infants in whom simultaneous arterial blood gas and systemic venous oxygen saturation measurements were performed on admission and at 6 and 24 hours after admission were included. Analyses of arterial pH, base excess, arteriovenous oxygen saturation differences, and oxygen extraction ratio were performed, including comparisons of survivors and nonsurvivors and changes over time.
Results:
Forty-nine infants were included in the study, with 39 survivors. There were no differences in any parameter between survivors and nonsurvivors on admission or at 24 hours. At 6 hours, differences between survivors and nonsurvivors were significant for arterial pH (7.48 versus 7.35, p<0.001), base excess (2.9 versus -4.3 mmol/L, p<0.01), arteriovenous oxygen saturation difference (34 versus 43, p<0.05), and oxygen extraction ratio (0.28 versus 0.53, p<0.001). The oxygen extraction ratio at 6 hours was at least 0.5 in 6 of 39 survivors and 7 of 10 nonsurvivors (p = 0.002).
Conclusions:
Infants who die after cardiac operations have significant derangements of oxygen transport at 6 hours after admission to the intensive care unit. Infants with an oxygen extraction ratio greater than 0.5 at 6 hours are at highest risk.
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