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The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis

Aparna Hoskote, MD^*, Jia Li, PhD^,, Chantal Hickey, MD, Simon Erickson, MD^*, Glen Van Arsdell, MD^||,¶, Derek Stephens, MSc^#, Helen Holtby, MD, Desmond Bohn, MD^* and Ian Adatia, MBChB^*,,,*

^* Department of Critical Care Medicine, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
Department of Pediatrics, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
Department of Anesthesia, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
^|| Department of Surgery, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
Department of Cardiology, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
^¶ Department of Cardiovascular Surgery, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada
^# Department of Biostatistics, Population Health Sciences, The Hospital for Sick Children, Toronto, Canada

View larger version (38K): [in a new window]   Figure 1 Arterial pH, arterial carbon dioxide tension (PaCO2), oxygen saturation (SaO2), and PaO2 at PaCO2 35, 45, 55, and 40 mm Hg. The lines represent individual patient values with the bold line indicating the mean value. *Adjusted p value for difference between PaCO2 35 and 45 mm Hg. Adjusted p value for difference between PaCO2 45 and 55 mm Hg. Adjusted p value for difference between PaCO2 55 and 40 mm Hg.

View larger version (21K): [in a new window]   Figure 2 Superior vena cava (SVC) oxygen saturation and inferior vena cava (IVC)/femoral venous (FV) oxygen saturation at CO2 35, 45, 55, and 40 mm Hg. The lines represent individual patient values, with the bold line indicating the mean value. *Adjusted p value for difference between arterial carbon dioxide tension (PaCO2) 35 and 45 mm Hg. Adjusted p value for difference between PaCO2 45 and 55 mm Hg. Adjusted p value for difference between PaCO2 55 and 40 mm Hg.

View larger version (40K): [in a new window]   Figure 3 Transcranial arterio-venous oxygen difference, near infrared spectroscopy (NIRS)-tissue oxygenation index, peak transcranial Doppler velocity, and mean transcranial Doppler velocity at CO2 35, 45, 55, and 40 mm Hg. The lines represent individual patient values, with the bold line indicating the mean value. Peak and mean transcranial Doppler measurements were not available at an arterial carbon dioxide tension (PaCO2) of 40 mm Hg in four patients. *Adjusted p value for difference between PaCO2 35 and 45 mm Hg. Adjusted p value for difference between PaCO2 45 and 55 mm Hg. Adjusted p value for difference between PaCO2 55 and 40 mm Hg.

View larger version (24K): [in a new window]   Figure 4 The pulmonary vascular resistance index (PVRI) remained unchanged at arterial carbon dioxide tension (PaCO2) 35, 45, 55, and 40 mm Hg. There was a significant decrease in superior vena cava pressure between PaCO2 55 and 40 mm Hg but no change in pulmonary vascular resistance as pulmonary blood flow decreased.