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Transpulmonary Thermodilution in Neonates Undergoing Arterial Switch Surgery

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Abstract

Measurement of the global end-diastolic volume index (GEDI) by transpulmonary thermodilution (TPTD) has become a useful technique for measuring preload in adults. This study aimed to investigate the hemodynamic changes in neonates during the postoperative period after arterial switch surgery. Over a 13-month period, the postoperative data of 12 neonates with transposition of the great arteries were retrospectively investigated. Arterial and central venous blood pressures were monitored, Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), GEDI, and extravascular lung water index (ELWI) were measured by thermodilution. The CI was significantly correlated with the SVRI only in the closed chest condition (r = −0.92; P < 0.001). The CI and SVI values were significantly lower and the ELWI and SVRI values significantly higher in both the open and closed chest conditions than the postextubation values. The relationship between change in GEDI and change in CI was stronger in the open chest condition (r = 0.93; P < 0.006) than in the closed chest condition (r = 0.75; P = 0.055). However, the latter just missed statistical significance. According to the findings, TPTD seems to be a useful tool for assessing cardiac function after neonatal arterial switch surgery. Establishment of normal values will be essential for proper guidance of therapy for this population using volumetric parameters.

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References

  1. Bland JM, Altman DG (1995) Calculating correlation coefficients with repeated observations. Part 2: correlation between subjects. BMJ 310:633

    CAS  PubMed  Google Scholar 

  2. Cecchetti C, Lubrano R, Cristaldi S, Stoppa F, Barbieri MA, Elli M, Masciangelo R, Perrotta D, Travasso E, Raggi C, Marano M, Pirozzi N (2008) Relationship between global end-diastolic volume and cardiac output in critically ill infants and children. Crit Care Med 36:928–932

    PubMed  Google Scholar 

  3. Egan JR, Festa M, Cole AD, Nunn GR, Gillis J, Winlaw DS (2005) Clinical assessment of cardiac performance in infants and children following cardiac surgery. Intensive Care Med 4:568–573

    Article  Google Scholar 

  4. Fakler U, Pauli Ch, Balling G, Lorenz HP, Eicken A, Hennig M, Hess J (2007) Cardiac index monitoring by pulse contour analysis and thermodilution after pediatric cardiac surgery. J Thorac Cardiovasc Surg 133:224–228

    Article  CAS  PubMed  Google Scholar 

  5. Goedje O, Peyerl M, Seebauer T, Lamm P, Mair H, Reichart B (1998) Central venous pressure, pulmonary capillary wedge pressure, and intrathoracic blood volumes as preload indicators in cardiac surgery patients. Eur J Cardiothorac Surg 13:533–539

    Article  Google Scholar 

  6. Goepfert MS, Reuter DA, Akyol D, Lamm P, Kilger E, Goetz A (2007) Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients. Intensive Care Med 33:96–103

    Article  PubMed  Google Scholar 

  7. Hazinski MF (1999) Cardiovascular disorders. In: Hazinski MF, Bowlus BJ (eds) The manual of pediatric critical care, 1st edn. CV Mosby, St. Louis, pp 112, 284–288

  8. Hoffman TM, Wernovsky G, Atz AM, Bailey JM, Akbary A, Kocsis JF, Nelson DP, Chang AC, Kulik TJ, Spray TL, Wessel DL (2002) Prophylactic intravenous use of milrinone after cardiac operation in pediatrics (PRIMACORP) study. Prophylactic Intravenous Use of Milrinone After Cardiac Operation in Pediatrics. Am Heart J 143:15–21

    Article  CAS  PubMed  Google Scholar 

  9. Laussen PC, Roth SJ (2003) Fast tracking: efficiently moving patients through the intensive care unit. Progr Ped Cardiol 18:149–158

    Article  Google Scholar 

  10. López-Herce J, Rupérez M, Sánchez C, García C, García E (2006) Estimation of the parameters of cardiac function and of blood volume by arterial thermodilution in an infant animal model. Pediatr Anesth 16:635–640

    Article  Google Scholar 

  11. Mahajan A, Shabanie A, Turner J, Sopher MJ, Marijic J (2003) Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease. Anesth Analg 97:1283–1288

    Article  PubMed  Google Scholar 

  12. Meissner U, Scharf J, Dötsch J, Schroth M (2008) Very early extubation after open-heart surgery in children does not influence cardiac function. Pediatr Cardiol. 29:317–320

    Article  CAS  PubMed  Google Scholar 

  13. Michard F (2007) Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls. Crit Care Med 35:1186–1192

    Article  PubMed  Google Scholar 

  14. Michard F, Alaja S, Zarka V, Bahloul M, Richard C, Teboul JL (2003) Global end diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124:1900–1908

    Article  PubMed  Google Scholar 

  15. Miller-Hoover SR (2003) Pediatric and neonatal cardiovascular pharmacology. Pediatr Nurs 29:105–113

    PubMed  Google Scholar 

  16. Mupanemunda RH (2006) Cardiovascular support of the sick neonate. Curr Pediatr 16:176–181

    Article  Google Scholar 

  17. Noori S, Seri I (2005) Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev 81:399–404

    Article  CAS  PubMed  Google Scholar 

  18. Ravishankar C, Tabbutt S, Wernovsky G (2003) Critical care in cardiovascular medicine. Curr Opin Pediatr 15:443–453

    Article  PubMed  Google Scholar 

  19. Renner J, Cavus E, Meybohm P, Gruenewald M, Steinfath M, Scholz J, Boening A, Bein B (2008) Pulse pressure variation and stroke volume variation during different loading conditions in a paediatric animal model. Acta Anaesthesiol Scand 52:374–380

    Article  CAS  PubMed  Google Scholar 

  20. Rupérez M, López-Herce J, García C, Sánchez C, García E, Vigil D (2004) Comparison between cardiac output measured by the pulmonary arterial thermodilution technique and that measured by the femoral arterial thermodilution technique in a pediatric animal model. Pediatr Cardiol 25:119–123

    Article  PubMed  Google Scholar 

  21. Schiffmann H, Erdlenbruch B, Singer D, Singer S, Herting E, Hoeft A, Buhre W (2002) Assessment of cardiac output, intravascular volume status, and extravascular lung water by transpulmonary indicator dilution in critically ill neonates and infants. J Cardiothorac Vasc Anesth 16:592–599

    Article  PubMed  Google Scholar 

  22. Skowno JJ, Broadhead M (2008) Cardiac output measurement in pediatric anesthesia. Paediatr Anaesth 18:1019–1028

    Article  PubMed  Google Scholar 

  23. Smetkin AA, Kirov MY, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ (2009) Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. Acta Anaesthesiol Scand 53:505–514

    Article  CAS  PubMed  Google Scholar 

  24. Tibby SM, Murdoch IA (2003) Monitoring cardiac function in intensive care. Arch Dis Child 88:46–52

    Article  CAS  PubMed  Google Scholar 

  25. Tibby SM, Hatherill M, Marsh MJ, Wilson P, Postle AD, Murdoch IA (1997) Clinical validation of cardiac output measurements using femoral artery thermodilution with direct Fick in ventilated children and infants. Intensive Care Med 23:987–991

    Article  CAS  PubMed  Google Scholar 

  26. Tibby SM, Hatherill M, Marsh MJ, Murdoch IA (2003) Clinicians’ abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 77:516–518

    Article  Google Scholar 

  27. Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castañeda AR, Newburger JW (1995) Postoperative course and hemodynamic profile after arterial switch operation in neonates and infants. Circulation 92:2226–2235

    CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by grants from the Hungarian Research Foundation (OTKA-T-035169), Budapest, Hungary; the Academy of Finland, Helsinki, Finland; Biocenter Oulu, Oulu, Finland; and the Sigrid Juselius Foundation, Helsinki, Finland. No conflict of interest exists.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Haller u. 29, Budapest, 1096, Hungary

    Andrea Székely, Tamás Breuer, Erzsébet Sápi & Edgár Székely

  2. Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, 1096, Hungary

    Tamás Breuer & András Szatmári

  3. Szentágothai János Knowledge Centre and Department of Health Sciences and Sport Medicine, Semmelweis University, Budapest, Hungary

    Miklós Tóth

  4. Department of Anesthesia and Intensive Care, Semmelweis University, Budapest, Hungary

    Balázs Hauser & János Gál

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  1. Andrea Székely
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  2. Tamás Breuer
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  3. Erzsébet Sápi
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  4. Edgár Székely
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  5. András Szatmári
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  6. Miklós Tóth
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  7. Balázs Hauser
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  8. János Gál
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Correspondence to Andrea Székely.

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Székely, A., Breuer, T., Sápi, E. et al. Transpulmonary Thermodilution in Neonates Undergoing Arterial Switch Surgery. Pediatr Cardiol 32, 125–130 (2011). https://doi.org/10.1007/s00246-010-9828-0

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  • DOI: https://doi.org/10.1007/s00246-010-9828-0

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