ABSTRACT
OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007. METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena cava respectively. Linear regression analysis was performed between ScvO2 and DeltapCO2. RESULTS: Fifty seven children aged from 5 days to 14 years were included and 272-paired simultaneous arterial and central venous samples were analyzed. Mean venous pCO2 was 47.82+/-9.03 mmHg and mean arterial pCO2 was 40.50+/-9.06 mmHg. One hundred seventy four samples had ScvO2 > 70% with mean DeltapCO2 of 5.44+/-2.55 mmHg and 98 samples had ScvO2 < 70% with mean DeltapCO2 of 9.07+/-3.90 mmHg. With ScvO2 < 70%, 77 samples had DeltapCO2 of > 6 mmHg while only 21 samples had DeltapCO2 of < 6 mmHg (p < 0.001). On the contrary with ScvO2 > 70%, 71 samples had DeltapCO2 of > 6 mmHg and 103 samples had DeltapCO2 of < 6 mmHg. Coefficient of correlation (R2) between 0.340 was ScvO2 and DeltapCO2. CONCLUSION: Elevated DeltapCO2 is practical and can be utilized as a useful adjunct to low ScvO2 in the assessment of low cardiac output syndrome in children after cardiac surgery.
Subject(s)
Carbon Dioxide/blood , Cardiac Output, Low/diagnosis , Cardiac Output , Heart Defects, Congenital , Oxygen/blood , Postoperative Complications/diagnosis , Adolescent , Biomarkers , Blood Gas Analysis , Cardiac Output, Low/blood , Child , Child, Preschool , Cohort Studies , Female , Heart Defects, Congenital/blood , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/statistics & numerical data , Male , Oxygen Consumption , Postoperative Complications/blood , Postoperative Period , Retrospective Studies , Risk Factors , Vena Cava, SuperiorABSTRACT
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether anticoagulation is indicated for patients in atrial fibrillation (AF) following coronary artery bypass grafting. Altogether 166 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. In addition the American Heart Association guidelines for management of atrial fibrillation were reviewed. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that patients post-cardiac surgery require warfarinisation while in atrial fibrillation with an INR of 2-3, and full anticoagulation should be commenced within 48 h of the onset of AF as their risk of stroke is doubled by the onset of AF.
