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Hyperventilation versus standard ventilation for infants in postoperative care for congenital heart defects with

Takako Umenai1, Nobuaki Shime, Satoru Hashimoto

  • 1Department of Anesthesiology and Intensive Care, University Hospital, Kyoto Prefectural School of Medicine, Kyoto, Japan.

Journal of Anesthesia
|February 24, 2009
PubMed

Insights

Hyperventilation in infants undergoing heart surgery may lead to lung injury and inflammation. Standard ventilation may be a safer alternative for preventing pulmonary hypertensive crisis.

Area of Science:

  • Pediatric Cardiac Surgery
  • Respiratory Physiology
  • Critical Care Medicine

Background:

  • Infants with cardiac defects and left-to-right shunts often receive hyperventilation to prevent pulmonary hypertensive crisis (PHC).
  • However, aggressive hyperventilation may cause lung injury and systemic inflammation.

Purpose of the Study:

  • This randomized study compared the effects of hyperventilation versus standard ventilation in infants undergoing corrective heart surgery.
  • To evaluate the impact on lung injury and systemic inflammatory response.

Main Methods:

  • 22 infants with a pulmonary-to-systemic blood pressure ratio > 0.7 were enrolled.
  • 11 infants received hyperventilation (10-12 ml/kg tidal volume) to maintain PaCO2 30-35 mmHg.
  • 11 infants received standard ventilation (6-8 ml/kg tidal volume).

Main Results:

  • Hyperventilation group had higher peak inspiratory pressure and lower PaCO2 and PEEP.
  • The PaCO2/FiO2 ratio decreased significantly in the hyperventilation group over 24 hours.
  • Serum IL-6 levels were lower in the standard ventilation group, indicating reduced inflammation.

Conclusions:

  • Hyperventilation in infants with pulmonary hypertension undergoing corrective heart surgery may increase lung injury and systemic inflammation.
  • Standard ventilation may be a safer approach in this patient population.
Abstract

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