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Ideal PaO2 on CPB for peds?

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  Quote pumper Quote  Post ReplyReply bullet Topic: Ideal PaO2 on CPB for peds?
    Posted: Oct 03 2007 at 6:20pm

Is the ideal PaO2 on CPB in peds 150 mmgh? is 120 mmgh safe enough when the child is at 37 degrees ? Is it right that PaO2 on CPB should be in the range of 95-150 mmgh ? I would appreciate your response.

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  Quote pumper Quote  Post ReplyReply bullet Posted: Oct 05 2007 at 7:14am

I'm still waiting for a response...

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  Quote wesmck Quote  Post ReplyReply bullet Posted: Oct 06 2007 at 11:17am
I typically keep my PaO2 above 150 mmHg while on bypass, however I would say that it is highly dependent upon several factors.  Is the patient warm and consuming an increased amount of oxygen, is the patient at adequate flows, do we have NIRS and are they adequate?  You really will have to decide whether or not you need a PaO2 greater than 150 mmHg based on your clinical judgement, but in most cases it should be adequate.
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  Quote pumper Quote  Post ReplyReply bullet Posted: Oct 08 2007 at 12:11pm
I posted this question because we had an incident of post-operative brain death in a 9 month old baby who came for TOF repair. The patient was acidotic through out the case, but not severely acidotic. The perfusionist was flowing with a C.I of 2.8 L/min/m2, PaO2 was 119mmgh for about one hour while the patient was fully warm (37 degrees) and consuming high amounts of oxygen. I was just wondering if this low PaO2 was one of the reasons for the post-op brain deathCry  
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  Quote wesmck Quote  Post ReplyReply bullet Posted: Oct 08 2007 at 3:48pm
Do you all utilize NIRS?  If so what were they doing during this case?  The other question I would suppose we should be considering is did this patient get an air embolus?  I would suspect if your blood gases appeared relatively normal and you weren't suspecting an oxygen deficeit the brain death would be due to lack of cerebral perfusion.  This points to the importance of utilizing some method of monitoring cerebral perfusion, either NIRS or TCD.
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  Quote pumper Quote  Post ReplyReply bullet Posted: Oct 10 2007 at 11:08am
I don't know about NIRS utilization during this case and I don't think that they were monitoring cerebral perfusion to be honest but I'm sure that the patient didn't get an air embolus. My question is that: was PaO2 of 119mmgh adequate enough for this baby while he was at 37 degrees for almost 1 hour or it should have been atleast 150 mmgh??
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  Quote kidsCCP Quote  Post ReplyReply bullet Posted: Oct 11 2007 at 8:36am

To answer your question... I do not feel that a PaO2 of 120 mm Hg could have been acceptable at 37 C.

PaO2 is a minor part of the bigger picture. I do not feel that you can say a PaO2 of a certain value is acceptable for every patient. All people are different and react differently. Each patient and each minute of CPB requires an examination of the situation and the patient's requirements at that time. Simply saying a PaO2 of a given value is acceptable, is frankly not acceptable.
 
I think that Perfusion Adequacy should be examined here... Look at VO2 plateauing, urine output (in kids is muted and not a great indicator but you should examine it), base excess and pH, lactate levels, venous saturation, NIRS, flow, arterial saturation, blood pressure, etc. All of these variables should be considered when examining adequacy of perfusion.
 
I think a discussion of Hct/Hgb level is also important. If you have a hgb of 7.0 and a PaO2 of 120 mm Hg this is a lot more detrimental than a Hgb of 12.5 and a PaO2 of 120 mm Hg
 
I run my hgb at 10 or higher. I run my PaO2 in the 150 to < 300 range.  But I move around inside this range and sometimes higher to maintain my venous saturation, VO2, pH, lactate, urine output, NIRS, etc. But I always try to maximize my flow first.
 
A problem of this sort requires a system wide examination. Examining the PaO2 will not fix this problem or those like it in the future.
 
 
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  Quote pumper Quote  Post ReplyReply bullet Posted: Oct 12 2007 at 7:36am
I would like to thank you all for your clear answeres that benefited me so much..
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