Systemic perfusion assessment in patients with univentricular hemodynamics based on blood gas parameters
A. B. Naumov,
Yu. S. Polushin,
G. G. Khubulava,
Yu. S. Аleksandrovich,
S. P. Marchenko,
K. V. Pshenisnov,
N. G. Pilyugov https://doi.org/10.21292/2078-5658-2020-17-3-6-16
Abstract
The objective: to identify laboratory markers of systemic perfusion in newborns with functional single ventricle on mechanical ventilation after surgical correction.
Subjects and methods. Blood gas parameters were retrospectively analyzed in 52 newborns with congenital heart defects with univentricular hemodynamic after surgical correction. All samples were divided into three groups based on arterial blood saturation (SaO2): Group 1 – hypoxia (SaO2 ≤ 65%); Group 2 – normoxemia (SaO2 = 65-85%); Group 3 – hyperoxemia (SaO2 > 85%). Stroke volume and cardiac index were evaluated with echocardiography. The oxygen consumption and carbon metabolism were evaluated by arterial and venous blood gases.
Results. The mixed central venous pO2 (PvO2) > 29.5 mm Hg, mixed central venous O2 (SvO2) > 54.5%, arteriovenous difference in saturation (Sa-vO2) < 15.8%, total oxygen content in venous blood (CvO2) > 119 ml/l, oxygen extraction ratio (O2ER) < 19% and the arteriovenous difference in partial pressure of carbon dioxide (dPCO2) < 5.4 mm Hg are cut off criteria for adequate systemic perfusion. PvO2 < 26 mm Hg, SvO2 < 44.5%, Sa-vO 2 > 27%, CvO2 < 88 ml/l, O2ER > 27.7%, dPCO2> 7.9 mm Hg have been associated with decreased systemic perfusion. The logistic regression model including combination of O2ER and dPCO2 predicts adequate systemic flow accuracy of 94.3% (sensitivity 87.5%, specificity 94.7%, p = 0.001). Graphics allow to adapt the mathematical model to clinical practice to verify systemic hypoperfusion in newborns with functional single ventricle.
Conclusion: The following cut off parameters allow to assess systemic perfusion in newborns with functional single ventricle: PvO2, SvO2, CvO2, Sa-vO 2, O2ER, and dPCO2. The model for predicting the adequacy of systemic perfusion can be used as an effective tool to monitor hemodynamic status in newborns with functional single ventricle.
About the Authors
A. B. Naumov
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Aleksey B. Naumov - Candidate of Medical Sciences, Associate Professor of Anesthesiology, Intensive Care and Emergency Pediatrics Department within Post-Graduate and Continuing Professional Development Faculty
2A, Litovskaya St., St. Petersburg, 194100
Yu. S. Polushin
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Yury S. Polushin - Doctor of Medical Sciences, Academician of RAS, Pro-Rector for Research, Head of Research Clinical Center of Anesthesiology and Intensive Care, Head of Anesthesiology and Intensive Care Department
6-8B, Lva Tolstogo St., St. Petersburg, 197022
G. G. Khubulava
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Gennadiy G. Khubulava - Doctor of Medical Sciences, Academician of RAS, Chief Cardiac Surgeon of the North-Western Federal District of the Russian Federation, Head of Faculty Surgery Department
6-8B, Lva Tolstogo St., St. Petersburg, 197022
Yu. S. Аleksandrovich
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Yury S. Аleksandrovich- Doctor of Medical Sciences, Professor, Pro-Rector for Post-Graduate and Continuing Professional
Education and Regional Public Health Development, Head of Anesthesiology, Intensive Care and Emergency Pediatrics Department within Post-Graduate and Continuing Professional Development Faculty
2A, Litovskaya St., St. Petersburg, 194100
S. P. Marchenko
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Sergey P. Marchenko - Doctor of Medical Sciences, Professor of Cardiovascular Surgery Department
6-8B, Lva Tolstogo St., St. Petersburg, 197022
K. V. Pshenisnov
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Konstantin V. Pshenisnov - Candidate of Medical Sciences, Associate Professor of Anesthesiology, Intensive Care
and Emergency Pediatrics Department within Post-Graduate and Continuing Professional Development Faculty
2A, Litovskaya St., St. Petersburg, 194100
N. G. Pilyugov
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Nikolay G. Pilyugov - Physician of Emergency Care Unit for Children with Cardiac Surgical Pathology
2A, Litovskaya St., St. Petersburg, 194100
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Review
For citations:
Naumov A.B., Polushin Yu.S., Khubulava G.G., Аleksandrovich Yu.S., Marchenko S.P., Pshenisnov K.V., Pilyugov N.G. Systemic perfusion assessment in patients with univentricular hemodynamics based on blood gas parameters. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2020;17(3):6-16. (In Russ.) https://doi.org/10.21292/2078-5658-2020-17-3-6-16
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