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CLINICAL STUDIES

Cardiorespiratory responses to negative pressure ventilation after tetralogy of Fallot repair: a hemodynamic tool for patients with a low-output state

^a Department of Pediatrics, Royal Brompton Hospital, London, England, United Kingdom
^* Department of Surgery, Royal Brompton Hospital, London, England, United Kingdom

Manuscript received March 20, 1998; revised manuscript received June 18, 1998, accepted October 26, 1998.

Reprint requests and correspondence: Professor A. Redington, Professor of Congenital Heart Disease, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom
reding{at}ibm.net

Objectives

We hypothesized that a period of cuirass negative pressure ventilation (NPV) would augment the cardiac output of patients in the early postoperative period after complete correction of tetralogy of Fallot (TOF).

Background

Diastolic right ventricular dysfunction can lead to a low-output state in an important minority of patients after TOF repair. In these patients, the diastolic pulmonary arterial flow, which characterizes restrictive right ventricular physiology, and on which the cardiac output is so dependent, is highly sensitive to changes in intrathoracic pressure.

Methods

The effects of NPV on pulmonary blood flow were investigated in 23 intubated children who were initially ventilated using intermittent positive pressure ventilation after TOF repair. Eight patients had restrictive right ventricular physiology. All children received a 15-min period of NPV, and eight received a prolonged period (45 min) of NPV.

Results

A brief period of NPV increased pulmonary blood flow by 39%, and the improvement further continued if the study period was extended, with a total increase of 67% after 45 min. Patients with restrictive physiology had a somewhat delayed response to NPV, but the ultimate increase during an extended period of NPV was greater in restrictive patients (84%) than nonrestrictive patients (50%).

Conclusions

By manipulating important cardiopulmonary interactions, NPV improves the cardiac output of patients after TOF repair, and has a role as a hemodynamic tool in the management of the low-output state in selected cases.

Abbreviations and Acronyms   CO2 = carbon dioxide   IPPV = intermittent positive pressure ventilation   NPV = negative pressure ventilation   O2 = oxygen   Qp = pulmonary blood flow index   TOF = tetralogy of Fallot

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