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PEDIATRIC ANESTHESIA

Changes in Respiratory Mechanics Among Infants Undergoing Heart Surgery

Stephen A. Stayer, MD^*,,, Laura K. Diaz, MD^*,, Debora L. East, RN, Jill N. Gouvion, RRT^||, Tracie L. Vencill, RRT^||, E. Dean McKenzie, MD^,¶, Charles D. Fraser, MD^,¶, and Dean B. Andropoulos, MD^*,, Section Editor

Departments of *Anesthesiology, Pediatrics, and ¶Surgery, Divisions of Pediatric Cardiovascular Anesthesiology and Congenital Heart Surgery, Baylor College of Medicine, ||Texas Children’s Hospital, Houston, Texas

Address correspondence and reprint requests to Stephen Stayer, MD, Texas Children’s Hospital, 6621 Fannin, WT 19345H, Houston, TX 77030-2399. Address e-mail to sstayer{at}bcm.tmc.edu

Children with excessive pulmonary blood flow (PBF) from congenital heart disease have abnormal respiratory mechanics. Exposure to hypothermic cardiopulmonary bypass (CPB) adversely affects lung function. We designed this study of 106 patients to determine the changes in respiratory mechanics in infants younger than 1 yr undergoing heart surgery. Dynamic respiratory compliance (Cdyn) and total respiratory resistance (Rrs) were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded: age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Repeated-measures analysis of variance with covariate analysis was used to determine the effect of each covariate on Cdyn and Rrs at the three time periods. Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. We consider that the benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of CPB on respiratory mechanics.

IMPLICATIONS: The benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of cardiopulmonary bypass on respiratory mechanics in infants.

This article has been cited by other articles:

				B. S. von Ungern-Sternberg, F. Petak, S. Saudan, M. Pellegrini, T. O. Erb, W. Habre, and Swiss Paediatric Respiratory Research Group Effect of cardiopulmonary bypass and aortic clamping on functional residual capacity and ventilation distribution in children. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1193 - 1198. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999