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Factors associated with renal oxygen extraction in mechanically ventilated children after the Norwood operation: insights from high fidelity haemodynamic data

Published online by Cambridge University Press:  24 May 2024

Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window] ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Juan S. Farias Open the ORCID record for Juan S. Farias [Opens in a new window] ,
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]  and
Joshua Wong Open the ORCID record for Joshua Wong [Opens in a new window]
Rohit S. Loomba
Affiliation:
Advocate Children’s Hospital, Chicago, IL, USA Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
Enrique G. Villarreal*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, Mexico
Juan S. Farias
Affiliation:
Children’s Mercy Hospital, Kansas City, MO, USA
Saul Flores
Affiliation:
Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Joshua Wong
Affiliation:
Advocate Children’s Hospital, Chicago, IL, USA
*
Corresponding author: E. G. Villarreal; Email: quique_villarreal93@hotmail.com
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Abstract

Background:

Maintaining the adequacy of systemic oxygen delivery is of utmost importance, particularly in critically ill children. Renal oxygen extraction can be utilised as metric of the balance between systemic oxygen delivery and oxygen consumption. The primary aim of this study was to determine what clinical factors are associated with renal oxygen extraction in children after Norwood procedure.

Methods:

Mechanically ventilated children who underwent Norwood procedure from 1 September, 2022 to 1 March, 2023 were identified as these patients had data collected and stored with high fidelity by the T3 software. Data regarding haemodynamic values, fluid balance, and airway pressure were collected and analysed using Bayesian regression to determine the association of the individual metrics with renal oxygen extraction.

Results:

A total of 27,270 datapoints were included in the final analyses. The resulting top two models explained had nearly 80% probability of being true and explained over 90% of the variance in renal oxygen extraction. The coefficients for each variable retained in the best were −1.70 for milrinone, −19.05 for epinephrine, 0.129 for mean airway pressure, −0.063 for mean arterial pressure, 0.111 for central venous pressure, 0.093 for arterial saturation, 0.006 for heart rate, −0.025 for respiratory rate, 0.366 for systemic vascular resistance, and −0.032 for systemic blood flow.

Conclusion:

Increased milrinone, epinephrine, mean arterial pressure, and systemic blood flow were associated with decreased (improved) renal oxygen extraction, while increased mean airway pressure, central venous pressure, arterial saturation, and systemic vascular resistance were associated with increased (worsened) renal oxygen extraction.

Keywords

Paediatric critical carerenal oxygen extractionNorwood operationBayesian regressionhaemodynamic factors
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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