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The Benefits of High‐flow Management in Children With Pulmonary Atresia
Author(s) -
Fujii Yasuhiro,
Kotani Yasuhiro,
Kawabata Takuya,
Ugaki Shinya,
Sakurai Shigeru,
Ebishima Hironori,
Itoh Hideshi,
Nakakura Mahito,
Arai Sadahiko,
Kasahara Shingo,
Sano Shunji,
Iwasaki Tatsuo,
Toda Yuichiro
Publication year - 2009
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2009.00895.x
Subject(s) - cardiopulmonary bypass , medicine , cardiac index , cardiology , hematocrit , anesthesia , surgery , hemodynamics , cardiac output
The high‐flow management of cardiopulmonary bypass (CPB; ≥2.4 L/min/m 2 ) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary‐collateral‐arteries and hypervascularization due to long‐term hypoxia. The purpose of this study was to describe the validity of high‐flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 ± 22 months. The blood‐pressure during bypass was controlled with the same protocol. The mean cooling‐temperature was 28.4 ± 3.7°C. The mean minimum hematocrit was 25.0 ± 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross‐clamping, the mean minimum flow index during aortic cross‐clamping, and the mean maximum flow index after rewarming were 3.1 ± 0.5, 3.1 ± 0.5, 2.6 ± 0.4, and 3.2 ± 0.4 L/min/m 2 , respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass ( R = 0.547, P = 0.007), the serum lactate levels at the end of CPB ( R = −0.442, P = 0.035), and the postoperative thoracic effusion ( R = −0.459, P = 0.028). A bypass flow index of 2.4 L/min/m 2 may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m 2 or more in this patient population.