Abstract
Purpose
Although it has been reported that the increase in blood pressure improves arterial oxygen saturation (SaO2) in children with tetralogy of Fallot, no prospective study has demonstrated that an increase in blood pressure induces an increase in pulmonary blood flow in these patients. The purpose of this study was to see whether a phenylephrine-induced increase in systemic blood pressure increased pulmonary blood flow, resulting in improved arterial oxygénation in tetralogy of Fallot.
Methods
In 14 consecutive children with tetralogy of Fallot (2–32 months old), transesophageal pulsed Doppler signals of left upper pulmonary venous flow (PVF) velocity were recorded before and four minutes after 10/μg · kg−1 of phenylephrine iv. Simultaneously, arterial blood gas analysis and hemodynamic measurements were performed. The minute distance (MD) was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF.
Results
Phenylephrine iv increased mean arterial blood pressure from 54 ± 8 mmHg to 73 ± 10 mmHg. This phenylephrineinduced hypertension significantly increased SaO2 and MD (92.0 ± 7.5 vs 95.0 ± 5.0% and 1318 ± 344 vs 1533 ± 425 cm · min−1, respectively). There was a significant correlation (r = 0.72) between the change in MD and the change in SaO2.
Conclusion
Our results suggest that the phenylephrine-induced increase in systemic blood pressure produces an increase in pulmonary blood flow in tetralogy of Fallot. Our results further suggest that this increase in pulmonary blood flow is involved in the mechanism of phenylephrine-induced improvement of arterial oxygenation in tetralogy of Fallot.
Résumé
Objectif
On a déjà montré qu’une augmentation de la tension artérielle améllore la saturation en oxygène du sang artériel (SaO2), chez les enfants qui présentent une tétralogie de Fallot, mais aucune étude prospective n’a démontré qu’une augmentation de la tension artérielle pouvait induire une élévation du débit sanguin pulmonaire chez ces patients. Nous voullons vérifier si une augmentation de la tension artérielle générale induite par la phényléphrine fait augmenter le débit sanguin pulmonaire et améliore l’oxygénation artérielle dans le contexte d’une tétralogie de Fallot.
Méthode
Chez 14 enfants porteurs d’une tétralogie de Fallot et traités consécutivement (âgés de 2–32 mois), les signaux Doppler pulsés transœsophagiens de la vitesse du flux de la veine pulmonaire gauche supérieure (DVP) ont été enregistrés avant, puis quatre minutes après l’administration iv de 10 μg · kg−1 de phényléphrine. Une analyse des gaz du sang artériel et des mesures hémodynamiques ont été réalisées simultanément. La distance minute (DM) a été calculée comme le produit de la fréquence cardiaque et de la somme des intégrales de temps-vélocité du DVR.
Résultats
La phényléphrine iv a augmenté la tension artérielle moyenne de 54 ± 8 mmHg à 73 ± 10 mmHg. L’hypertension induite par la phényiéphrine a augmenté la SaO2 et la DM de façon significative (92,0 ± 7,5 vs 95,0 ± 5,0 % et 1318 ± 344 vs 1533 ± 425 cm · min−1, respectivement). Il y avait une corrélation significative (r = 0,72) entre les modifications de la DM et celles de la SaO2.
Conclusion
Nos résultats suggèrent que, chez les patients atteints d’une tétralogie de Fallot, l’augmentation du débit sanguin général induite par la phényiéphrine produit une élévation du débit sanguin pulmonaire. De plus, il apparaît que cette augmentation du débit sanguin pulmonaire contribue à l’amélioration de l’oxygénation artérielle induite par la phényiéphrine.
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Tanaka, K., Kitahata, H., Kawahito, S. et al. Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot. Can J Anesth 50, 926–929 (2003). https://doi.org/10.1007/BF03018741
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DOI: https://doi.org/10.1007/BF03018741