title: Mechanical Ventilation After Bidirectional Superior Cavopulmonary Anastomosis for Single-Ventricle Physiology: A Comparison of Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist.
abstract: We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and arterial oxygenation in single-ventricle patients after bidirectional superior cavopulmonary anastomosis (BCPA). We hypothesized that preserved auto-regulation of respiration during neurally adjusted ventilatory assist (NAVA) may have potential advantages for CBF and pulmonary blood flow regulation after the BCPA procedure. We enrolled 23 patients scheduled for BCPA, who underwent pressure-controlled ventilation (PCV), pressure support ventilation (PSV), and NAVA at two assist levels for all modes in a randomized order. PCV targeting large V T (15 mL × kg(-1)) resulted in lower CBF and oxygenation compared to targeting low V T (10 mL × kg(-1)). During PSV and NAVA, ventilation assist levels were titrated to reduce EAdi from baseline by 75 % (high assist) and 50 % (low assist). High assist levels during PSV (PSVhigh) were associated with lower PaCO2, PaO2, and O2SAT, lower CBF, and higher pulsatility index compared with those during NAVAhigh. There were no differences in parameters when using low assist levels, except for slightly greater oxygenation in the NAVAlow group. Modifying assist levels during NAVA did not influence hemodynamics, cerebral perfusion, or gas exchange. Targeting the larger V T during PCV resulted in hyperventilation, did not improve oxygenation, and was accompanied by reduced CBF. Similarly, high assist levels during PSV led to mild hyperventilation, resulting in reduced CBF. NAVA's results were independent of the assist level chosen, causing normalized PaCO2, improved oxygenation, and better CBF than did any other mode, with the exception of PSV at low assist levels.
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China. zhulimin121@hotmail.com.
authors.forename: Limin
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Zhuoming
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Gong
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Jinghao
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Han
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, China.
authors.forename: Jinfen
authors.initials: J
authors.lastname: Liu
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rimensberger
mesh_terms: D018610:Heart Bypass, Right; D006801:Humans; D059725:Interactive Ventilatory Support; D011175:Positive-Pressure Respiration; D012119:Respiration; D012121:Respiration, Artificial
keywords: Bidirectional superior cavopulmonary anastomosis; Cerebrovascular circulation; Congenital; Heart defect; Mechanical ventilation; Neurally adjusted ventilatory assist