Admission arterial oxygen saturation was significantly lower in composite versus control group (93.4% vs 97.1% p = 0.005). Alveolar dead-space fraction greater than or equal to 0.29 indicated a 37% increase in risk to meet composite criteria. Alveolar dead-space fraction was significantly higher in the composite (0.33 ± 0.14) versus control (0.25 ± 0.26 p = 0.016) group. Of 128 patients undergoing Fontan operation, 34 met criteria for composite outcome.
Secondary endpoints were parameters of severity of illness, chest drainage duration, and length of stay. Associations between alveolar dead-space fraction and arterial oxyhemoglobin saturation to a composite outcome (surgical or catheter-based intervention, extracorporeal membrane oxygenation use, prolonged ventilation, prolonged hospital length of stay, or death) were explored. The association of alveolar dead-space fraction with clinical outcomes in patients undergoing Fontan operation has not been reported.Ī retrospective charts review of all pediatric patients who underwent Fontan surgery during June 2010-November 2018 in a tertiary-care pediatric hospital. Increased alveolar dead-space fraction has been associated with prolonged mechanical ventilation and worse outcome after congenital heart surgery.
Alveolar dead-space fraction represents the portion of inhaled air that does not participate in gas exchange and hence quantifies ventilation-perfusion abnormalities in the lung. A decrease in pulmonary blood flow can lead to major complications and grave outcomes. Fontan surgery, the final surgical stage in single ventricle palliation, redirects systemic venous blood into the pulmonary circulation for gas exchange.
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