Effects of oxygen, positive end-expiratory pressure, and carbon dioxide on oxygen delivery in an animal model of the univentricular heart Christopher.

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Presentation transcript:

Effects of oxygen, positive end-expiratory pressure, and carbon dioxide on oxygen delivery in an animal model of the univentricular heart Christopher J. Riordan, MDa, Flemming Randsbaek, MS, John H. Storey, MD, William D. Montgomery, BS, William P. Santamore, PhD, Erle H. Austin, MD The Journal of Thoracic and Cardiovascular Surgery Volume 112, Issue 3, Pages 644-654 (September 1996) DOI: 10.1016/S0022-5223(96)70047-8 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 The completed animal model. Flow probes are depicted about the graft and the aorta. The tricuspid valvotomy and the atrial septal defect are not depicted. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Relation of Fio2 and the Qp/Qs ratio, systemic vascular and pulmonary vascular resistance (SVR and PVR), and oxygen delivery. Upper panel: As Fio2 is decreased the Qp/Qs ratio decreases. Middle panel: Systemic vascular resistance is unchanged by changes in Fio2, while pulmonary vascular resistance increases when Fio2 decreases to 50% or less. Lower panel: Oxygen delivery is maximal for Fio2 50%. This Fio2 is associated with a Qp/Qs of 0.7. *p < 0.05 compared with baseline or maximal value in lower panel. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Relation of Fio2 and the Qp/Qs ratio, systemic vascular and pulmonary vascular resistance (SVR and PVR), and oxygen delivery. Upper panel: As Fio2 is decreased the Qp/Qs ratio decreases. Middle panel: Systemic vascular resistance is unchanged by changes in Fio2, while pulmonary vascular resistance increases when Fio2 decreases to 50% or less. Lower panel: Oxygen delivery is maximal for Fio2 50%. This Fio2 is associated with a Qp/Qs of 0.7. *p < 0.05 compared with baseline or maximal value in lower panel. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Relation of Fio2 and the Qp/Qs ratio, systemic vascular and pulmonary vascular resistance (SVR and PVR), and oxygen delivery. Upper panel: As Fio2 is decreased the Qp/Qs ratio decreases. Middle panel: Systemic vascular resistance is unchanged by changes in Fio2, while pulmonary vascular resistance increases when Fio2 decreases to 50% or less. Lower panel: Oxygen delivery is maximal for Fio2 50%. This Fio2 is associated with a Qp/Qs of 0.7. *p < 0.05 compared with baseline or maximal value in lower panel. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Influence of the Qp/Qs ratio on oxygen delivery. Oxygen delivery is at a maximum for a Qp/Qs ratio of about 0.7, and it decreases when the Qp/Qs ratio either increases or decreases from this range. *p < 0.05 compared with maximal value for oxygen delivery. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Relation of Sao2 and Svo2 to the Qp/Qs ratio. Upper panel: Sao2 increases as the Qp/Qs ratio increases, but it plateaus for higher values of Qp/Qs. Lower panel: Svo2 increases as the Qp/Qs ratio increases, reaches a maximum at a Qp/Qs ratio slightly less than 1, and then decreases for higher Qp/Qs ratios. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Relation of Sao2 and Svo2 to the Qp/Qs ratio. Upper panel: Sao2 increases as the Qp/Qs ratio increases, but it plateaus for higher values of Qp/Qs. Lower panel: Svo2 increases as the Qp/Qs ratio increases, reaches a maximum at a Qp/Qs ratio slightly less than 1, and then decreases for higher Qp/Qs ratios. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Relation of PEEP, the Qp/Qs ratio, and systemic vascular and pulmonary vascular resistance. Upper panel: The Qp/Qs ratio decreases as PEEP is increased. This effect adds to the effects of lower Fio2. Middle panel: This effect is largely due to the increase seen in pulmonary vascular resistance. *p < 0.05 compared with baseline (0 PEEP). Lower panel: Effect of PEEP on oxygen delivery is not constant. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Relation of PEEP, the Qp/Qs ratio, and systemic vascular and pulmonary vascular resistance. Upper panel: The Qp/Qs ratio decreases as PEEP is increased. This effect adds to the effects of lower Fio2. Middle panel: This effect is largely due to the increase seen in pulmonary vascular resistance. *p < 0.05 compared with baseline (0 PEEP). Lower panel: Effect of PEEP on oxygen delivery is not constant. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Relation of PEEP, the Qp/Qs ratio, and systemic vascular and pulmonary vascular resistance. Upper panel: The Qp/Qs ratio decreases as PEEP is increased. This effect adds to the effects of lower Fio2. Middle panel: This effect is largely due to the increase seen in pulmonary vascular resistance. *p < 0.05 compared with baseline (0 PEEP). Lower panel: Effect of PEEP on oxygen delivery is not constant. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Relation of Sao2 and Svo2 to oxygen delivery. Upper panel: Sao2 becomes a poor predictor of oxygen for higher values of Sao2 (r = 0.26). Lower panel: Good correlation between Sao2 and oxygen delivery (r = 0.82). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Relation of Sao2 and Svo2 to oxygen delivery. Upper panel: Sao2 becomes a poor predictor of oxygen for higher values of Sao2 (r = 0.26). Lower panel: Good correlation between Sao2 and oxygen delivery (r = 0.82). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 644-654DOI: (10.1016/S0022-5223(96)70047-8) Copyright © 1996 Mosby, Inc. Terms and Conditions