Abstract | PURPOSE: In infants undergoing surgery for cardiac defects with left-to-right shunt, a hyperventilation strategy has been applied to prevent pulmonary hypertensive crisis (PHC). Hyperventilation with a large tidal volume and/or higher airway pressure, however, may be detrimental to the lung. This randomized study compared the effects of hyperventilation versus standard ventilation. METHODS: We enrolled 22 infants with a preoperative pulmonary-to-systemic blood pressure ratio of more than 0.7. Hyperventilation, with a tidal volume of 10-12 ml x kg(-1) to keep Pa(CO2) between 30 and 35 mmHg, was randomly applied in 11 patients for 16 h or more. The other 11 patients were randomly assigned to standard ventilation, with a 6- to 8- ml x kg(-1) tidal volume. RESULTS: The peak inspiratory pressure was higher (20 +/- 3 vs 18 +/- 2 cmH2O; P = 0.018), and Pa(CO2) (34 +/- 5 vs 42 +/- 7 mmHg; P = 0.003) and positive end-expiratory pressure (3 +/- 0 vs 5 +/- 0; P < 0.0001) were significantly lower in the hyperventilation than in the standard ventilation group. The Pa(CO2)/inspiratory fraction of oxygen Pa(CO2) ratio decreased from 244 +/- 160 mmHg at the onset of postoperative ventilation, to 177 +/- 96 mmHg at 24 h (P = 0.038) in the hyperventilation group, versus a decrease from 240 +/- 89 to 220 +/- 97 mmHg in the standard ventilation group not significant (NS). Serum interleukin (IL)-6 level, measured at 24 h postoperatively, was significantly lower (P = 0.02) in the standard ventilation than in the hyperventilation group, suggesting an attenuated postoperative systemic inflammatory response. A single patient in each group developed PHC. CONCLUSION:
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Authors | Takako Umenai, Nobuaki Shime, Satoru Hashimoto |
Journal | Journal of anesthesia
(J Anesth)
Vol. 23
Issue 1
Pg. 80-6
( 2009)
ISSN: 1438-8359 [Electronic] Japan |
PMID | 19234828
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Interleukin-6
- Carbon Dioxide
- C-Reactive Protein
- Oxygen
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Topics |
- Blood Pressure
(physiology)
- C-Reactive Protein
(metabolism)
- Carbon Dioxide
(blood)
- Cardiac Surgical Procedures
(methods)
- Female
- Heart Defects, Congenital
(surgery)
- Humans
- Hypertension, Pulmonary
(surgery)
- Hyperventilation
- Infant
- Interleukin-6
(blood)
- Male
- Oxygen
(blood)
- Pilot Projects
- Positive-Pressure Respiration
- Postoperative Care
(methods)
- Pulmonary Circulation
- Pulmonary Gas Exchange
- Respiration, Artificial
- Treatment Outcome
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