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The Organ-Protective Effect of Higher Partial Pressure of Arterial Carbon Dioxide in the Normal Range for Infant Patients Undergoing Ventricular Septal Defect Repair

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Abstract

Hypercapnia has been reported to play an active role in protection against organ injury. The aim of this study was to determine whether a higher level of partial pressure of arterial carbon dioxide (PaCO2) within the normal range in pediatric patients undergoing cardiac surgery had a similar organ-protective effect. From May 2017 to May 2018, 83 consecutive infant patients undergoing ventricular septal defect (VSD) repair with cardiopulmonary bypass were retrospectively enrolled. We recorded the end-expiratory tidal partial pressure of carbon dioxide (Pet-CO2) as an indirect and continuous way to reflect the PaCO2. The patients were divided into a low PaCO2 group (LPG; 30 mmHg < Pet-CO2 < 40 mmHg) and a high PaCO2 group (HPG; 40 mmHg < Pet-CO2 < 50 mmHg). The regional cerebral oxygen saturation (rScO2), cerebral blood flow velocity (CBFV), and hemodynamics at five time points throughout the operation, and perioperative data were recorded and analyzed for the two groups. In total, 34 LPG and 49 HPG patients were included. Demographics and perioperative clinical data showed no significant difference between the groups. Compared with LPG, the HPG produced lower postoperative creatine kinase isoenzyme-MB (40.88 versus 50.34 ng/mL, P = 0.038). The postoperative C-reactive protein of HPG trended lower than in LPG (61.09 versus 73.4 mg/L, P = 0.056). The rScO2 and mean CBFV of HPG were significantly higher compared with LPG (P < 0.05) except at the end of cardiopulmonary bypass. Hemodynamic data showed no significant difference between the groups. As a convenient and safe approach, higher-normal PaCO2 could attenuate brain injury, heart injury, and inflammatory response in infant patients undergoing VSD repair.

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Abbreviations

ABG:

Arterial blood gas

BSA:

Body surface area

CBFV:

Cerebral blood flow velocity

CCE:

Cardiac cycle efficiency

Ccr:

Creatinine clearance rate

CHD:

Congenital heart disease

CI:

Cardiac index

CK:

Creatine kinase

CKMB:

Creatine kinase isoenzyme-MB

CPB:

Cardiopulmonary bypass

CRP:

C-creative protein

CS-AKI:

Cardiac surgery-associated kidney injury

DiaP:

Diastolic blood pressure

DicP:

Dicrotic blood pressure

dp/dtmax :

Maximal slope of systolic upstroke

FiO2 :

Fraction of inspire O2

HCA:

Hypercapnic acidosis

HPG:

High PaCO2 group

ICAM:

Intracellular adhesion molecule

ICU:

Intensive care unit

IL:

Interleukin

LPG:

Low PaCO2 group

IS:

Inotropic score

MCA:

Middle cerebral artery

MV:

Minute volume

NF:

Nuclear factor

NIRS:

Near-infrared spectroscopy

OI:

Oxygenation index

PaCO2 :

Partial pressure of arterial carbon dioxide

Pet-CO2 :

End-expiratory tidal partial pressure of carbon dioxide

PPV:

Pulse pressure variation

PRAM:

Pressure recording analytical method

rScO2 :

Regional cerebral oxygen saturation

SCr:

Serum creatinine

SVRI:

Systemic vascular resistance index

SysP:

Systolic blood pressure

TCD:

Transcranial Doppler

TNF:

Tumor necrosis factor

TV:

Tidal volume

V max :

Maximum flow velocity

V mean :

Mean flow velocity

V min :

Minimum flow velocity

VSD:

Ventricular septal defect

WBC:

White blood cell

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Acknowledgements

We would like to acknowledge the physicians of the pediatric cardiac center of Beijing Anzhen Hospital.

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Author notes

  1. Chuan Ou-Yang and Yinglong Liu have contributed equally to this work.

Authors and Affiliations

  1. Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Fan Fan & Yinglong Liu

  2. Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China

    Siyuan Xie

  3. Anesthesia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Chuan Ou-Yang

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  1. Fan Fan
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  2. Siyuan Xie
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  3. Chuan Ou-Yang
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  4. Yinglong Liu
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Correspondence to Yinglong Liu.

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The authors declare that they have no conflict of interest.

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The institutional review board at Anzhen Hospital approved the use of clinical data for this study and the informed consent was obtained from all individual participants included in the study.

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Fan, F., Xie, S., Ou-Yang, C. et al. The Organ-Protective Effect of Higher Partial Pressure of Arterial Carbon Dioxide in the Normal Range for Infant Patients Undergoing Ventricular Septal Defect Repair. Pediatr Cardiol 41, 372–381 (2020). https://doi.org/10.1007/s00246-019-02269-y

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