Pediatric Cardiology

, Volume 40, Issue 1, pp 182–187 | Cite as

Relationship Between Pulmonary-to-Systemic-Blood-Flow Ratio (Qp:Qs) Based on Cardiac Catheterization and Indices Derived from Simultaneously Measured End Tidal CO2 (EtCO2) in Children with Complex Congenital Heart Disease

  • Jigar C. ChauhanEmail author
  • Rituparna Deb
Original Article


CO2 removal by the lungs depends upon ventilation and pulmonary blood flow, with end tidal CO2 (EtCO2) as surrogate for it. We studied indices based on EtCO2 measured routinely during anesthesia for cardiac catheterization, along with simultaneously calculated Qp:Qs (pulmonary-to-systemic-blood-flow ratio) in children with complex congenital heart disease to assess the relationship between these measures. A retrospective, single-center, correlational cohort study was conducted at a tertiary-care, free-standing children’s hospital. All included subjects had Qp:Qs calculated as well as EtCO2 and PaCO2 documented during a single cardiac catheterization. Children with stage-1 single ventricle or complex biventricular repair with highly variable Qp:Qs were defined as Group 1, and Group 2 comprised those with stage 2 or 3 repairs with less variable Qp:Qs. Exclusion criteria were uncuffed artificial airway, EtCO2 > PaCO2, and abnormally high Qp:Qs. EtCO2 indices were defined as EtCO2:PaCO2 (alveolar functional fraction) and EtCO2 gap (PaCO2–EtCO2). Correlation coefficients were obtained between Qp:Qs and EtCO2 indices in both groups. A total of 29 patients in Group 1 and 24 in Group 2 underwent final analysis. Even with highly variable Qp:Qs, Group 1 showed a strong correlation between Qp:Qs and EtCO2:PaCO2 (r = 0.83, p < 0.0001). A similarly strong correlation was maintained in Group 2 (r = 0.79, p < 0.0001) and in both groups combined (r = 0.86, p < 0.0001). A very strong negative correlation was present between Qp:Qs and EtCO2 gap (r = − 0.77, p < 0.0001). EtCO2:PaCO2 has a very strong correlation with Qp:Qs simultaneously calculated during catheterization. It can be an additional parameter to estimate Qp:Qs in critical management of children with congenital heart disease. Our results also provide a basis for future prospective studies to assess dynamic changes in EtCO2-based indices and Qp:Qs.


Children EtCO2 Qp:Qs PaCO2 Congenital heart disease Cardiac catheterization 


Compliance with Ethical Standards

Conflict of interest

Jigar Chauhan, Rituparna Deb declares that they have no conflict of interest.

Ethical Approval

All the procedures performed in studies involving human participants were reviewed by the Institutional Review Board (IRB) for adherence to the ethical standards and were approved. The requirement of informed consent was waived by the IRB, because the study was a retrospective observation study and involved no more than minimal risk to the participants.

Research Involving Animal and Human Participants

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric Critical Care Medicine, Department of PediatricsNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Nemours DuPont PediatricsSeafordUSA

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