title: Mechanical ventilation strategy following Glenn and Fontan surgeries: On going challenge!
abstract: The Glenn and Fontan operations put the pulmonary and systemic circulations in series. It has been shown that positive pressure ventilation (PPV) decreases pulmonary blood flow (PBF) and cardiac output (CO), and negative pressure ventilation (NPV) significantly improves PBF and CO. If early extubation is not achievable, the postoperative ventilator management strategy should aim at promoting PBF and CO by lowering pulmonary vascular resistance (PVR) and intrathoracic pressure. Multiple ventilator strategies have been evaluated to optimize this physiology, including high frequency ventilation, hyperventilation post Glenn, hypoventilation post Glenn with buffered pH, and the use of inhaled nitric oxide as an adjunct therapy for mechanical ventilation. In this review, the results of these studies will be reviewed and discussed.
authors: Pediatric Critical Care Division, Department of Pediatrics, King Khalid University Hospital, King Saud University, Saudi Arabia.
authors: Ayman
authors: A
authors: Al-Eyadhy
keywords: CO, cardiac output; CO2, carbon dioxide; IVC, inferior Vena Cava; NPV, negative pressure ventilation; PBF, pulmonary blood flow; PDA, patent ductus arteriosus; PEEP, positive end-expiratory pressure; PPV, positive pressure ventilation; PVR, pulmonary vascular resistance; SaO2, arterial saturation; TPG, transpulmonary gradient; iNO, inhaled nitric oxide
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