Dead space fractions in neonates following first-stage palliation for hypoplastic left heart syndrome. (17th April 2019)

• Record Type: Journal Article
• Authors: Anton-Martin, Pilar; Joshi, Rhucha; Rao, Mounica; Pandurangi, Sindhu; Wellnitz, Chasity; Kang, Paul; Nigro, John J.; Velez, Daniel; Willis, Brigham C.
• Is Part Of: Cardiology in the young. Volume 29:Number 4(2019)
• Page Start: 481
• Page End: 487
• Publication Date: 2019-04-17
• Subjects: Hypoplastic left heart syndrome, -- Norwood procedure, -- Blalock–Taussig shunt, -- Sano shunt, -- hybrid procedure, -- dead space; Pediatric cardiology -- Periodicals; 618.9212
• DOI: 10.1017/S1047951119000076
• Languages: English
• ISSNs: 1047-9511

Abstract

Abstract: Purpose: (1) To characterise changes in dead space fraction during the first 120 post-operative hours in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome, including hybrid procedure; (2) to document whether dead space fraction varied by shunt type (Blalock–Taussig shunt and Sano) and hybrid procedure; and (3) to determine the association between dead space fraction and outcomes. Methods: Retrospective chart review in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome in a cardiac intensive care unit over a consecutive 30-month period. A linear mixed model was used to determine the differences in dead space over time. Multivariable linear regression and a multivariable linear mixed model were used to assess the association between dead space and outcomes at different time points and over time, respectively. Results: Thirty-four neonates received either a Blalock–Taussig shunt (20.5%), Sano shunt (59%), or hybrid procedure (20.5%). Hospital mortality was 8.8%. Dead space fractions in patients undergoing the hybrid procedure were significantly lower on day 1 (p = 0.01) and day 2 (p = 0.02) and increased over time. A dead space fraction >0.6 on post-operative days 3–5 was significantly associated with decreased duration of mechanical ventilation in all surgical groups (p < 0.001). Conclusions: Dead space fraction >0.6 on post-operative days 3–5 was associated with lower duration of mechanical ventilation in all surgical groups. A more comprehensive, prospective assessment of dead space in this delicate patient population would likely be beneficial in improving outcomes.