ABSTRACT
Objective To investigate the clinical significance and correlation of end-tidalcarbon dioxide partial pressure (PetCO2) and arterial blood carbon dioxide pressure (PaCO2) of children with different types of congenital heart disease in perioperative period of cardiopulmonary bypass.Methods 60 children undergoing selective cardiopulmonary bypass surgery for congenital heart disease were chosen (aged 1-14 years old, ASA class II or III).According to echocardiographic results, the children were divided into two groups. Group A:Left-to-right shunt in children, involving 15 cases of atrial septal defect and 15 cases of ventricular septal defect;Group B: Right-to-left shunt in children, involving 30 cases of Fallot tetrad. All 60 children underwent intravenous general anesthesia and rapid induction of orotracheal intubation. All patients underwent ventilator-assisted ventilation in the surgical intensive care unit for 8 hours after surgery. The brachial artery blood was collected for arterial blood gas analysis to measure PaCO2 at the beginning of surgery (T1), 15 min after anesthesia (T2), before CPB (T3), 15 min after CPB (T4), end of surgery (T5), time to transfer to SICU (T6), 2 h after monitored in ICU (T7), 4 h after monitored in SICU (T8), 6 h after monitored in SICU (T9), 8 h after monitored in SICU (T10).The PaCO2 and PetCO2 were recorded at each time point. According to the result of PetCO2 and PaCO2, we studied the correlation of the two indexes at each time point.Results In group A, there was a positive correlation between PetCO2 and PaCO2 at each time point (the correlation was 0.55 to 0.87, P＜0.001). The correlation between PETCO2 and PaCO2 decreased gradually during T2-6, and the correlation gradually increased during T7-10. There was no significant correlation between PetCO2 and PaCO2 (the correlation was0.21 to 0.38, P＞ 0.05) before operation in group B until 15 minutes after CPB. From the end of surgery to 8 hours after SICU monitoring, PetCO2 was positively correlated with PaCO2 (the correlation was0.54 to 0.83, P ＜ 0.05).The correlation between the two indexes increased gradually during T5-10. Conclusions During the perioperative period of cardiopulmonary bypass, PetCO2 can be used as an evaluation indicator for clinical monitoring in the children with Left-to-right shunt of congenital heart disease.There was no significant correlation between PetCO2 and PaCO2 in the children with congenital heart disease of right-to-left shunting before the end of surgery. PetCO2 could not replace PaCO2.With the improvement of postoperative conditions, It is significant to dynamically observe changes in PetCO2 to guide the analysis of PaCO2.
ABSTRACT
<p><b>BACKGROUND</b>The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.</p><p><b>METHODS</b>Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥ 34 weeks' gestational age, admitted at < 72 hours of age, requiring continuous positive airway pressure (CPAP) or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns (ACoRN) Respiratory Score < 5, 5 - 8, and > 8.</p><p><b>RESULTS</b>During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was (36.8 ± 2.2) weeks, mean birth weight was (2734.5 ± 603.5) g. The majority of the neonates were male (69.4%), late preterm (63.3%), delivered by cesarean section (74.8%), admitted in the first day of life (89.3%) and outborn (born at other hospitals, 76.9%). Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score < 7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed. Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion, bicarbonate infusion or vasopressors therapy (P < 0.05). The incidence of complications was also increased significantly in severe group (P < 0.05). The in-hospital mortality in the severe group was significantly higher than other two groups (P < 0.05). ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version II (SNAP-II) (P < 0.01). High gestational age, high SNAP-II score and oxygenation index (OI), and Apgar score at 5 minutes < 5 were independent risks for death.</p><p><b>CONCLUSIONS</b>Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-II score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.</p>