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Age-related cerebrovascular carbon dioxide reactivity in children with ventricular septal defect younger than 3 years

Boqun Cui1, Chuan Ou-Yang1, Siyuan Xie1,2

  • 1Anesthesia Center, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China.

Paediatric Anaesthesia
|July 11, 2020
PubMed

Insights

Carbon dioxide reactivity and cerebral oxygen saturation improve with age in young children undergoing heart surgery. This suggests age-related maturation of cerebrovascular regulation in this vulnerable population.

Area of Science:

  • Pediatric Cardiology
  • Neuroscience
  • Anesthesiology

Background:

  • Impaired cerebrovascular reactivity to carbon dioxide is linked to neurological issues in pediatric cardiac surgery patients.
  • Understanding CO2 reactivity and cerebral oxygenation is crucial for managing neurological risks in young children.

Purpose of the Study:

  • To assess carbon dioxide reactivity in children younger than 3 years undergoing cardiac repair.
  • To evaluate regional cerebral oxygen saturation (rSO2) in relation to age and CO2 levels in this cohort.

Main Methods:

  • Children younger than 3 years undergoing ventricular septal defect repair were grouped by age (<6 months, 6-12 months, 12-36 months).
  • Cerebral CO2 reactivity was measured using transcranial Doppler (TCD) during controlled ventilation.
  • Regional cerebral oxygen saturation (rSO2) was monitored using near-infrared spectroscopy (NIRS).

Main Results:

  • Cerebral CO2 reactivity significantly increased with age, from 4.42% in infants <6 months to 7.58% in children 12-36 months (P < .001).
  • Regional cerebral oxygen saturation (rSO2) also showed a significant increase with age (65% to 70%, P = .027).
  • rSO2 positively correlated with end-tidal CO2 pressure across all age groups (P < .001).

Conclusions:

  • Abnormal cerebrovascular CO2 reactivity is common in children under 3 years undergoing cardiac surgery.
  • The degree of CO2 reactivity varies significantly with age, indicating developmental changes in cerebrovascular control.
  • These findings highlight the importance of age-specific monitoring and management of CO2 levels to optimize cerebral oxygenation.
Abstract

Keywords:
agecarbon dioxide reactivitycongenital heart diseaseregional cerebral oxygen saturation

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