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(Circulation. 1998;98:1407-1413.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Estimation of Oxygen Delivery in Newborns With a Univentricular Circulation

Ofer Barnea, PhD; William P. Santamore, PhD; Anthony Rossi, MD; Ellis Salloum, MD; Sufan Chien, MD; ; Erle H. Austin, MD

From the Biomedical Engineering Department, Tel Aviv University, Israel (O.B.); the Department of Surgery, University of Louisville, Ky (W.P.S., E.S., S.C., E.H.A.); and the Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY.

Correspondence to Dr Ofer Barnea, Biomedical Engineering Department, Faculty of Engineering, Tel Aviv University, Ramat Aviv 69978, Israel.

Background—The management of neonates with complex congenital anomalies depends on careful interpretation of arterial blood gas values. Improved interpretation of these oxygen parameters may allow clinicians to avoid unexpected cardiovascular events. This study examined whether systemic oxygen delivery (DO₂) can be maximized by the use of indices derived from oxygen saturation measurements in neonates with hypoplastic left heart syndrome.

Methods and Results—For the single-ventricle heart with both circulations in parallel, we used a previously developed computer simulation to obtain DO₂ as a function of systemic arterial (SaO₂) and venous (SvO₂) oxygen saturation, arteriovenous oxygen difference (Sa-vO₂), or pulmonary-to-systemic flow ratio (Qp/Qs). We also examined the oxygen excess factor, SaO₂/Sa-vO₂ (). We found that (1) slight increases in SaO₂ may be associated with large decreases in DO₂. (2) Low values for SvO₂ indicate low values for DO₂. (3) Curves for Sa-vO₂ and Qp/Qs are redundant in the data provided. (Qp/Qs, however, provides these data in more physiologically relevant terms.) (4) High values for Qp/Qs (>4) are associated with low DO₂. (5) Estimating Qp/Qs from oxygen saturation measurements may result in errors when pulmonary venous oxygen saturation is not available. (6) Maximizing DO₂ is extremely difficult using SaO₂, SvO₂, and Qp/Qs. (7) A linear relationship exists between and DO₂, and this linear relationship is not altered by changes in cardiac output.

Conclusions—Patients with low SvO₂ values require attention. Ideally, after reducing Qp/Qs to <1.5, might be a better index to guide further therapy and maximize DO₂. Interventions that increased would be considered beneficial, whereas interventions that decreased would be considered detrimental.

Key Words: computers • hypoplastic left heart syndrome • hemodynamics • oxygen • pediatrics

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