Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: A pilot study

Awni Al-Subu, Edmund Jooste, Christoph P. Hornik, Gregory A. Fleming, Ira M. Cheifetz, George Ofori-Amanfo

Research output: Contribution to journalArticle

Abstract

Background: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management. Aims: The aim of this study was to assess the correlation between volume of CO2 elimination obtained by volumetric capnography and pulmonary blood flow in pediatric patients with single-ventricle physiology after stage 1 palliation as well as in patients with other cardiac lesions associated with intracardiac shunting. Methods: This prospective cohort study included children with congenital or acquired heart disease who underwent cardiac catheterization as part of clinical care. Cardiac output, pulmonary blood flow, and volume of CO2 elimination were simultaneously collected. Spearman's rank correlation coefficients were used to assess correlation between measurements after controlling for minute ventilation. Results: Thirty-five patients were enrolled and divided into 3 groups. Group 1 (n = 8) included single-ventricle patients after stage 1 palliation. Group 2 (n = 10) patients had structural heart disease with 2 ventricles and intracardiac shunting. Group 3 (n = 17) had structurally normal hearts. Among Group 1 patients, the correlation coefficients (R2) between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.60 (P =.02) 95% CI [0.01-0.79] and 0.29 (P =.74) 95% CI [−0.91 - 0.86], respectively. In patients with 2 ventricles associated with intracardiac shunts (Group 2), the correlation coefficients between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.86 (P =.001) 95% CI [0.53 - 0.97] and 0.73 (P =.001) 95% CI [0.29 - 0.95], respectively. Among Group 3 patients, the correlation coefficient between volume of CO2 elimination and pulmonary blood flow was 0.66 (P =.038) 95% CI [0.29 - 0.87]. Conclusion: Volume of CO2 elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO2 elimination may be a marker of cardiac output.

Original languageEnglish (US)
Pages (from-to)618-624
Number of pages7
JournalPaediatric Anaesthesia
Volume28
Issue number7
DOIs
StatePublished - Jul 1 2018

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Carbon Dioxide
Cardiac Output
Blood Volume
Lung
Cardiac Catheterization
Pulmonary Elimination
Heart Diseases
Capnography
Cardiac Volume
Nonparametric Statistics
Pulmonary Artery
Ventilation
Anatomy
Cohort Studies
Catheters
Biomarkers
Hemodynamics
Prospective Studies
Pediatrics

Keywords

  • capnography
  • cardiac output
  • congenital heart disease
  • pulmonary blood flow
  • volume of CO elimination

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

Cite this

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts : A pilot study. / Al-Subu, Awni; Jooste, Edmund; Hornik, Christoph P.; Fleming, Gregory A.; Cheifetz, Ira M.; Ofori-Amanfo, George.

In: Paediatric Anaesthesia, Vol. 28, No. 7, 01.07.2018, p. 618-624.

Research output: Contribution to journalArticle

Al-Subu, Awni ; Jooste, Edmund ; Hornik, Christoph P. ; Fleming, Gregory A. ; Cheifetz, Ira M. ; Ofori-Amanfo, George. / Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts : A pilot study. In: Paediatric Anaesthesia. 2018 ; Vol. 28, No. 7. pp. 618-624.
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abstract = "Background: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management. Aims: The aim of this study was to assess the correlation between volume of CO2 elimination obtained by volumetric capnography and pulmonary blood flow in pediatric patients with single-ventricle physiology after stage 1 palliation as well as in patients with other cardiac lesions associated with intracardiac shunting. Methods: This prospective cohort study included children with congenital or acquired heart disease who underwent cardiac catheterization as part of clinical care. Cardiac output, pulmonary blood flow, and volume of CO2 elimination were simultaneously collected. Spearman's rank correlation coefficients were used to assess correlation between measurements after controlling for minute ventilation. Results: Thirty-five patients were enrolled and divided into 3 groups. Group 1 (n = 8) included single-ventricle patients after stage 1 palliation. Group 2 (n = 10) patients had structural heart disease with 2 ventricles and intracardiac shunting. Group 3 (n = 17) had structurally normal hearts. Among Group 1 patients, the correlation coefficients (R2) between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.60 (P =.02) 95{\%} CI [0.01-0.79] and 0.29 (P =.74) 95{\%} CI [−0.91 - 0.86], respectively. In patients with 2 ventricles associated with intracardiac shunts (Group 2), the correlation coefficients between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.86 (P =.001) 95{\%} CI [0.53 - 0.97] and 0.73 (P =.001) 95{\%} CI [0.29 - 0.95], respectively. Among Group 3 patients, the correlation coefficient between volume of CO2 elimination and pulmonary blood flow was 0.66 (P =.038) 95{\%} CI [0.29 - 0.87]. Conclusion: Volume of CO2 elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO2 elimination may be a marker of cardiac output.",
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T1 - Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts

T2 - A pilot study

AU - Al-Subu, Awni

AU - Jooste, Edmund

AU - Hornik, Christoph P.

AU - Fleming, Gregory A.

AU - Cheifetz, Ira M.

AU - Ofori-Amanfo, George

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management. Aims: The aim of this study was to assess the correlation between volume of CO2 elimination obtained by volumetric capnography and pulmonary blood flow in pediatric patients with single-ventricle physiology after stage 1 palliation as well as in patients with other cardiac lesions associated with intracardiac shunting. Methods: This prospective cohort study included children with congenital or acquired heart disease who underwent cardiac catheterization as part of clinical care. Cardiac output, pulmonary blood flow, and volume of CO2 elimination were simultaneously collected. Spearman's rank correlation coefficients were used to assess correlation between measurements after controlling for minute ventilation. Results: Thirty-five patients were enrolled and divided into 3 groups. Group 1 (n = 8) included single-ventricle patients after stage 1 palliation. Group 2 (n = 10) patients had structural heart disease with 2 ventricles and intracardiac shunting. Group 3 (n = 17) had structurally normal hearts. Among Group 1 patients, the correlation coefficients (R2) between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.60 (P =.02) 95% CI [0.01-0.79] and 0.29 (P =.74) 95% CI [−0.91 - 0.86], respectively. In patients with 2 ventricles associated with intracardiac shunts (Group 2), the correlation coefficients between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.86 (P =.001) 95% CI [0.53 - 0.97] and 0.73 (P =.001) 95% CI [0.29 - 0.95], respectively. Among Group 3 patients, the correlation coefficient between volume of CO2 elimination and pulmonary blood flow was 0.66 (P =.038) 95% CI [0.29 - 0.87]. Conclusion: Volume of CO2 elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO2 elimination may be a marker of cardiac output.

AB - Background: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management. Aims: The aim of this study was to assess the correlation between volume of CO2 elimination obtained by volumetric capnography and pulmonary blood flow in pediatric patients with single-ventricle physiology after stage 1 palliation as well as in patients with other cardiac lesions associated with intracardiac shunting. Methods: This prospective cohort study included children with congenital or acquired heart disease who underwent cardiac catheterization as part of clinical care. Cardiac output, pulmonary blood flow, and volume of CO2 elimination were simultaneously collected. Spearman's rank correlation coefficients were used to assess correlation between measurements after controlling for minute ventilation. Results: Thirty-five patients were enrolled and divided into 3 groups. Group 1 (n = 8) included single-ventricle patients after stage 1 palliation. Group 2 (n = 10) patients had structural heart disease with 2 ventricles and intracardiac shunting. Group 3 (n = 17) had structurally normal hearts. Among Group 1 patients, the correlation coefficients (R2) between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.60 (P =.02) 95% CI [0.01-0.79] and 0.29 (P =.74) 95% CI [−0.91 - 0.86], respectively. In patients with 2 ventricles associated with intracardiac shunts (Group 2), the correlation coefficients between volume of CO2 elimination and pulmonary blood flow and volume of CO2 elimination and cardiac output were 0.86 (P =.001) 95% CI [0.53 - 0.97] and 0.73 (P =.001) 95% CI [0.29 - 0.95], respectively. Among Group 3 patients, the correlation coefficient between volume of CO2 elimination and pulmonary blood flow was 0.66 (P =.038) 95% CI [0.29 - 0.87]. Conclusion: Volume of CO2 elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO2 elimination may be a marker of cardiac output.

KW - capnography

KW - cardiac output

KW - congenital heart disease

KW - pulmonary blood flow

KW - volume of CO elimination

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