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Effect of corrective or palliative procedures on arterial to end-tidal carbon dioxide pressure difference in

Eissa Bilehjani1, Solmaz Fakhari1, Alireza Yaghoubi1

  • 1Departments of Anesthesiology, Tabriz University of Medical Sciences, Madani Heart Hospital, Tabriz, Iran.

African Journal of Paediatric Surgery : AJPS
|July 11, 2019
PubMed

Insights

The difference between arterial and end-tidal carbon dioxide (DPCO2) did not change after palliative cardiac surgery in children. While DPCO2 decreased after corrective surgery, it remained elevated, suggesting limited clinical value for monitoring these procedures.

Area of Science:

  • Pediatric Cardiology
  • Cardiothoracic Surgery
  • Respiratory Physiology

Background:

  • The difference between arterial and end-tidal carbon dioxide (DPCO2) is normally small (3-5 mmHg) but increases in children with congenital heart disease.
  • Congenital heart disease can lead to altered cardiopulmonary physiology, affecting gas exchange.

Purpose of the Study:

  • To evaluate the impact of corrective or palliative cardiac surgery on the DPCO2 in pediatric patients.
  • To determine if changes in DPCO2 correlate with surgical outcomes or can serve as a monitoring tool.

Main Methods:

  • A prospective study involving 200 children under 12 years old undergoing corrective or palliative cardiac surgery.
  • DPCO2 was measured using arterial blood gas analysis and simultaneous capnography during intra- and postoperative periods.
  • DPCO2 values were compared between and within corrective and palliative surgical groups.

Main Results:

  • Initial DPCO2 was elevated in both corrective (15.50 ± 13.1 mmHg) and palliative (10.75 ± 9.1 mmHg) groups.
  • DPCO2 was higher in the palliative group, except early post-procedure. Palliative procedures did not alter final DPCO2.
  • DPCO2 significantly decreased after corrective surgery but did not normalize. Corrective procedures had longer operation times and higher inotropic support needs; palliative procedures required longer ventilatory support.

Conclusions:

  • DPCO2 remains unchanged following palliative cardiac procedures in children.
  • Corrective cardiac surgery leads to a significant decrease in DPCO2, though levels do not return to normal in the early postoperative phase.
  • DPCO2 may not be a clinically valuable parameter for monitoring the quality of corrective or palliative cardiac procedures in this population.
Abstract

Keywords:
Arterial to end-tidal carbon dioxide pressure differencecongenital heart diseasesend-tidal carbon dioxide pressurepediatric cardiac surgery

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