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Alterations in plasma phosphorus, red cell 2,3-diphosphoglycerate and P50 following open heart surgery
R A Hasan1, A P Sarnaik, K L Meert
1Department of Pediatrics and Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA.
Insights
Pediatric heart surgery patients showed reduced plasma phosphorus, red cell 2,3-diphosphoglycerate (DPG), and P50 post-operation. These changes may impair oxygen use, critical for recovery.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Biochemistry
Background:
- Open heart surgery in children can impact physiological parameters.
- Understanding changes in oxygen-carrying capacity is vital for postoperative care.
Purpose of the Study:
- To assess alterations in plasma phosphorus, red cell 2,3-diphosphoglycerate (DPG), adenosine triphosphate (ATP), and P50 in pediatric patients after heart surgery.
- To investigate correlations between these biochemical markers and P50.
Main Methods:
- Prospective observational study in a pediatric intensive care unit.
- Measured plasma phosphorus, red cell 2,3-DPG, ATP, P50, and arterial lactate in 20 children before and up to 72 hours after open heart surgery.
- Analyzed data using repeated measure ANOVA and correlation coefficients.
Main Results:
- A significant reduction in plasma phosphorus, red cell 2,3-DPG, and P50 was observed post-surgery.
- Arterial lactate levels increased during the postoperative period.
- Red cell 2,3-DPG correlated with P50, and plasma phosphorus changes correlated with fluid and glucose administration.
Conclusions:
- Open heart surgery in children leads to decreased red cell 2,3-DPG, P50, and plasma phosphorus.
- These biochemical shifts may compromise tissue oxygen utilization, a critical factor in the postoperative recovery phase.
Objectives:
To evaluate changes in and the correlation between plasma phosphorus, red cell 2,3-diphosphoglycerate (DPG) and adenosine triphosphate (ATP), and P50 in children following heart surgery.
Experimental Design:
Prospective, observational study with factorial design.
Setting:
A pediatric intensive care unit in a university hospital.
Patients:
Twenty children undergoing open heart surgery for congenital heart defects.
Interventions:
None.
Measures:
Red cell 2,3-DPG and ATP, P50, plasma phosphorus, and arterial lactate were obtained before and at 1, 8, 16, 24, 48, and 72 hours after surgery. The amount of intravenous fluid and glucose administered, and age of blood utilized were documented. Variables were analyzed by repeated measure analysis of variance followed by paired t-tests. To investigate the relationship between variables at each time point, scatterplot matrices and correlation coefficients were obtained.
Results:
There was a reduction in plasma phosphorus, red cell 2,3-DPG, and P50 and an increase in arterial lactate at 1, 8, 16, 24, 48, and 72 hours after surgery. Red cell 2,3-DPG correlated with P50 at 1, 8 and 16 hours. The decrease in the plasma phosphorus correlated with the amounts of intravenous fluid and glucose administered on the day of surgery and on the first and second postoperative days. The age of the blood utilized correlated with the decrease in red cell 2,3-DPG on the day of surgery.
Conclusions:
Reduction in red cell 2,3-DPG, P50, and plasma phosphorus occurs after open heart surgery in children. These changes can potentially contribute to impaired oxygen utilization in the postoperative period, when adequacy of tissue oxygenation is critical.