A Novel Technique for the Administration of Sub-Ambient Oxygen in the Operating Room

Hypoplastic left heart syndrome (HLHS) is a common form of congenital heart disease with abnormal development of left-sided structures of the heart. As excessive pulmonary blood flow is common prior to palliative surgical procedures, therapeutic maneuvers may be required to decrease pulmonary blood flow and augment systemic cardiac output. Respiratory manipulations to optimize the ratio of pulmonary to systemic blood flow may include techniques to induce hypercarbia or the delivery of sub-ambient concentrations of oxygen (FiO₂ less than 0.21). We present a neonate with HLHS who required intraoperative care during a stage I hybrid procedure. Options for the intraoperative administration of a sub-ambient concentration of oxygen are presented.