title: Comparison of actual oxygen delivery kinetics to those predicted by mathematical modeling following stage 1 palliation just prior to superior cavopulmonary anastomosis.
abstract: BACKGROUND
  Optimizing systemic oxygen delivery (DO2) and hemodynamics in children with hypoplastic left heart syndrome (HLHS) is a clinical challenge. Mathematical modeling of the HLHS circulation has been used to determine the relationship between oxygen kinetic parameters and DO2 and to determine how DO2 might be optimized. The model demonstrates that neither arterial oxygen saturation (SaO2) nor mixed venous oxygen saturation (SvO2) alone accurately predicts DO2.
  
  
  OBJECTIVE
  Oxygen delivery kinetics predicted by previously described mathematical modeling were compared with actual patients' hemodynamic data. We sought to determine which patient derived parameters correlated best with DO2.
  
  
  METHODS
  Patients with HLHS who underwent cardiac catheterization prior to surgery to create a superior cavopulmonary anastomosis from 2007 to 2011 were identified. Hemodynamic data obtained were compared with the data derived from the mathematical model. Correlations between SaO2, SvO2, SaO2-SvO2, SaO2/(SaO2-SvO2), pulmonary-to-systemic blood flow ratio (Qp/Qs), and DO2 were evaluated using both linear and nonlinear analyses, and R(2) was calculated.
  
  
  CONCLUSIONS
  Patients' data fit most aspects of the mathematical model. DO2 had the best correlation with SaO2/(SaO2-SvO2; R(2) = 0.8755) followed by SaO2 -SvO2 (R(2) = 0.8063), while SaO2 or SvO2 alone did not demonstrate a significant correlation as predicated by the mathematical model (R(2) = 0.09564 and 0.4831, respectively). SaO2/(SaO2 -SvO2) would be useful clinically to track changes in DO2 that occur with changes in patient condition or with interventions.
authors.affiliation: Cardiac Anesthesia Division, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuki
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
mesh_terms: D005260:Female; D018610:Heart Bypass, Right; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D008962:Models, Theoretical; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D010101:Oxygen Consumption / Q000502:physiology*; D010166:Palliative Care; D015203:Reproducibility of Results
chemical_list: D010100:Oxygen
keywords: Qp/Qs; cardiac catheterization; hypoplastic left heart syndrome; mathematical model; oxygen delivery; stage 1 procedure