The effect of hypocapnia on systemic perfusion in patients with single ventricle after surgery
A. В. Naumov,
G. G. Khubulava,
Yu. S. Аleksandrovich,
S. P. Marchenko,
К. V. Pshenisnov,
N. G. Pilyugov https://doi.org/10.21292/2078-5658-2021-18-1-65-74
Abstract
The objective: the aim of the study was to identify the relationship between arterial hypocapnia and systemic hypoperfusion in newborns with single ventricular physiology after hemodynamic correction of congenital heart disease.
Subjects and methods. 125 newborns with congenital heart defects operated from 2014 to 2018 were examined retrospectively. Arterial and central venous blood gases were collected in the postoperative period. A total of 670 pairs of laboratory results were selected.
Results. Based on the presence/absence of hypocapnia (PaCO2 less than 35 mm Hg), 2 groups were formed. Group G-0 (the hypocapnic variant of the single-ventricular circulation) comprised 44 observations. Group G-1 (PaCO2 more than 35 mm Hg) included 40 observations. In 32 (38%) cases the level of systemic perfusion was within the normal range, in 52 (62%) cases, systemic hypoperfusion was detected. In samples corresponding to Group G-1, signs of DOS were observed in 20 cases. The study showed that the most pronounced intergroup difference in parametric data was observed among indicators reflecting oxygen consumption and, as a consequence, the system flow rate (РO2 in mixed venous blood, saturation in mixed venous blood, arterio-venous difference in saturation, O2 content in venous blood, O2 extraction ratio, arterio-venous difference in РCO2). In addition, the HF markers such as arterio-venous difference in saturation, O2 extraction ratio, arterio-venous difference in РCO2 had a strong correlation with the signs of systemic hypoperfusion. In the hypocapnic group, the tendency for more pronounced desaturation of venous blood was determined, and a higher arterio-venous difference in saturation, O2 content in venous blood, O2 extraction ratio, and arterio-venous difference in РCO2 parameters were also noted.
Conclusions. Arterial hypocapnia may be a sign of pulmonary overflow and reduction of systemic blood flow in newborns with single ventricular physiology, after hemodynamic correction of congenital heart disease. When managing newborns with parallel circulation, hypocapnia should be avoided as a factor contributing to the redistribution of blood flow from left to right and the development of systemic hypoperfusion.
About the Authors
A. В. 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
2, Litovskaya St., St. Petersburg, 194100
Phone: +7 (812) 591–79–11
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
Phone: +7 (812) 234–57–04
Yu. S. Аleksandrovich
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Yury S.Sergey 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
2, Litovskaya St., St. Petersburg, 194100
Phone: +7 (812) 591–79–11
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
Phone: +7 (812) 234–57–04
К. 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 Additional Professional Development Faculty, Anesthesiologist and Emergency Physician of Clinical Hospital
2, Litovskaya St., St. Petersburg, 194100
Phone: +7 (812) 591–79–11
N. G. Pilyugov
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Nikolay G. Pilyugov Anesthesiologist and Emergency Physician of Emergency Care Unit for Children with Cardiac Surgical Pathology
2, Litovskaya St., St. Petersburg, 194100
Phone: +7 (812) 591–79–11
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Review
For citations:
Naumov A.В., Khubulava G.G., Аleksandrovich Yu.S., Marchenko S.P., Pshenisnov К.V., Pilyugov N.G. The effect of hypocapnia on systemic perfusion in patients with single ventricle after surgery. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(1):65-74. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-1-65-74
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