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Pulmonary vascular resistance after cardiopulmonary bypass in infants: effect on postoperative recovery
I Schulze-Neick1, J Li, D J Penny
1Cardiothoracic Unit, Great Ormond Street Hospital, Great Ormond St., London WC1N 3JH, United Kingdom.
Insights
Increased pulmonary vascular resistance significantly impacts infant recovery after heart surgery. Managing this resistance is crucial for shorter mechanical ventilation times and better outcomes post-cardiopulmonary bypass.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Congenital heart operations often require cardiopulmonary bypass (CPB).
- Postoperative pulmonary vascular resistance (PVR) is a critical factor influencing recovery in infants.
- Understanding the contemporary impact of elevated PVR is essential for optimizing patient care.
Purpose of the Study:
- To define the clinical effect of elevated PVR in infants following cardiac surgery with CPB.
- To investigate the correlation between PVR and the duration of mechanical ventilation.
- To assess interventions aimed at reducing PVR in the postoperative period.
Main Methods:
- Fifteen infants undergoing cardiac operations with CPB were studied.
- Pulmonary vascular resistance was measured using the direct Fick principle and respiratory mass spectrometry.
- The effects of oxygen, L-arginine, substance P, and inhaled nitric oxide on PVR were assessed.
Main Results:
- Baseline PVR (11.7 WU.m^2) was reduced to a minimum of 6.1 WU.m^2.
- Ventilatory time (median 1.75 days) directly correlated with the lowest PVR achieved (r^2=0.64, P<.01).
- Infants with >2 days of ventilation had higher PVR and a correlation between CPB time and ventilation duration (r^2=0.48, P<.05).
Conclusions:
- Elevated PVR significantly affects postoperative recovery in infants after CPB.
- PVR may act as a surrogate for the systemic inflammatory response post-CPB.
- Management strategies targeting PVR are vital for improving outcomes in pediatric cardiac surgery.
Objective:
We sought to define the contemporary clinical effect of increased pulmonary vascular resistance in infants after congenital heart operations with cardiopulmonary bypass.
Methods:
Fifteen infants (median age, 0.31 years; median weight, 5.1 kg) underwent cardiac operations involving cardiopulmonary bypass (range, 49-147 minutes). Pulmonary vascular resistance was measured in the immediate postoperative period in the intensive care unit by means of the direct Fick principle, with respiratory mass spectrometry to measure oxygen consumption. The effect of ventilation with an inspired oxygen fraction of 0.65, with additional infusion of L -arginine, substance P, and inhaled nitric oxide, was assessed and subsequently correlated with the length of mechanical ventilation from the end of cardiopulmonary bypass to successful extubation.
Results:
Overall, pulmonary vascular resistance at baseline (11.7 +/- 5.6 WU. m(2)) could be reduced to a minimum of 6.1 +/- 3.5 WU. m(2). The ventilatory time was 0.86 to 14.9 days (median, 1.75 days) and correlated directly with the lowest pulmonary vascular resistance value achieved during the pulmonary vascular resistance study (r (2) = 0.64, P <.01). The patient subgroup with mechanical ventilation of greater than 2 days had significantly higher pulmonary vascular resistance at all stages of the study protocol, and in this group there was a correlation of cardiopulmonary bypass time and ventilatory support time (r (2) = 0.48, P <.05).
Conclusion:
Increased pulmonary vascular resistance, either directly or as a surrogate of the systemic inflammatory response after cardiopulmonary bypass, continues to have a significant effect on postoperative recovery of infants after cardiac operations.
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