The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure

Li, Jia; Zhang, Gencheng; Holtby, Helen; Guerguerian, Anne‐Marie; Cai, Sally; Humpl, Tilman; Caldarone, Christopher A.; Redington, Andrew N.; Arsdell, Glen S. Van

doi:10.1016/j.jtcvs.2007.07.036

Cited by 49 publications

(43 citation statements)

References 38 publications

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“…In the future, improvements in the technology are needed to address these shortcomings. Nonetheless, the composite VO 2 , SBF, and DO 2 data in the postintervention group are consistent with those described by Li and colleagues and Mackie et al using alternative technologies.…”

Section: Discussionsupporting

confidence: 89%

Phosphodiesterase Inhibitor‐Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation

Mills

Kaza

Walsh

et al. 2016

JAHA

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BackgroundSystemic vasodilation using α‐receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following stage 1 palliation (S1P), primarily when utilizing the modified Blalock‐Taussig shunt. We studied the effects of a protocol in which milrinone was primarily used to lower systemic vascular resistance (SVR) following S1P using the right ventricular to pulmonary artery shunt, measuring its effects on oxygen delivery (DO 2) profiles and clinical outcomes. We also correlated Fick‐based assessments of DO 2 with commonly used surrogate measures.Methods and ResultsNeonates undergoing S1P were treated according to best clinical judgment prior to (n=32) and following (n=24) implementation of a protocol that guided operative, anesthetic, and postoperative management, particularly as it related to SVR. A majority of the subjects (n=51) received a modified right ventricular to pulmonary artery shunt. In a subset of these patients (n=21), oxygen consumption (VO 2) was measured and used to calculate SVR, DO 2, and oxygen debt. Neonates treated with the protocol had significantly lower SVR (P=0.02), serum lactate (P<0.001), and Sa‐vO 2 difference (P<0.001) and a lower incidence of CPR requiring extracorporeal membrane oxygenation (E‐CPR, P=0.02) within the first 72 postoperative hours. DO 2 was closely associated with SVR (r2=0.78) but correlated poorly with arterial (SaO2) and venous (SvO2) oxyhemoglobin concentrations, the Sa‐vO 2 difference, and blood pressure.ConclusionsA vasodilator protocol utilizing milrinone following S1P effectively decreased SVR, improved serum lactate, and decreased postoperative cardiac arrest. DO 2 correlated more closely with SVR than with Sa‐vO 2 difference, highlighting the importance of measuring VO 2 in this population.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184169.

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Section: Discussionsupporting

confidence: 89%

Phosphodiesterase Inhibitor‐Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation

Mills

Kaza

Walsh

et al. 2016

JAHA

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“…49 NIRS has also been used to follow hemodynamic changes in CHD neonates after the Norwood procedure, suggesting that cerebral hemodynamics were influenced by external interventions and postoperative events. 50 The present feasibility study demonstrates potential for relating neurological outcome and cerebral hemodynamics in this early period after surgery by demonstrating the use of an alloptical, bedside monitor during this presurgical period that could safely be deployed at the bedside. We measure hemodynamic CO 2 reactivity in response to induced hypercapnia, which, as mentioned earlier, could be related to the neurological outcome ͑to be demonstrated in a future, larger study͒.…”

Section: Introductionmentioning

confidence: 80%

Optical measurement of cerebral hemodynamics and oxygen metabolism in neonates with congenital heart defects

et al. 2010

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Abstract. We employ a hybrid diffuse correlation spectroscopy ͑DCS͒ and near-infrared spectroscopy ͑NIRS͒ monitor for neonates with congenital heart disease ͑n =33͒. The NIRS-DCS device measured changes during hypercapnia of oxyhemoglobin, deoxyhemoglobin, and total hemoglobin concentrations; cerebral blood flow ͑rCBF DCS ͒; and oxygen metabolism ͑rCMRO 2 ͒. Concurrent measurements with arterial spin-labeled magnetic resonance imaging ͑rCBF ASL-MRI , n =12͒ cross-validate rCBF DCS against rCBF ASL-MRI , showing good agreement ͑R = 0.7, p = 0.01͒. The study demonstrates use of NIRS-DCS on a critically ill neonatal population, and the results indicate that the optical technology is a promising clinical method for monitoring this population.

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“…Studies have validated NIRS as a noninvasive method of monitoring cerebral oxygenation in children. 12,13 NIRS assesses the relative absorption of light by nonpulsatile hemoglobin species. 14 Thus, the oxygen saturation represents a mixed vascular hemoglobin oxygen saturation of arterioles, capillaries and venules.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamics and Cerebral Oxygenation Following Repair of Tetralogy of Fallot: The Effects of Converting From Positive Pressure Ventilation to Spontaneous Breathing

Bronicki¹,

Herrera²,

Mink³

et al. 2010

Congenital Heart Disease

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The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure

Cited by 49 publications

References 38 publications

Phosphodiesterase Inhibitor‐Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation

Phosphodiesterase Inhibitor‐Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation

Optical measurement of cerebral hemodynamics and oxygen metabolism in neonates with congenital heart defects

Hemodynamics and Cerebral Oxygenation Following Repair of Tetralogy of Fallot: The Effects of Converting From Positive Pressure Ventilation to Spontaneous Breathing

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