Cardiothoracic & vascular anesthesia
Hemodynamic Effects of Altering Tidal Volume During Positive Pressure Ventilation in the Fontan Circulation: A Randomized Crossover Trial
Primary result · Transpulmonary gradientResult — go to the resultDifference 0.2 95% CI −0.2 to 0.6Authors' conclusion
This randomized, crossover pilot trial of Fontan patients showed that a low VT ventilation (5 mL/kg) resulted in significantly lower peak and mean airway pressure compared with a high VT ventilation (10 mL/kg). However, there were no significant changes in transpulmonary gradient, mean Fontan pressure, or TEE parameters of stroke volume, pulmonary blood flow, or Fontan flow.
Study context
- Population
- Postoperative patients with a Fontan circulation, in the operating room at the end of cardiac surgeryincluded in final analysis
- Participants
- Eleven patients
- Comparison
- Low VT vs high VT ventilation
- Primary endpoint
- Transpulmonary gradient (Fontan pressure minus left atrial pressure)
- Follow-up
- After 5 min in each ventilation condition
Methodological detailssingle-center, pilot
- Single-center
- Pilot
Primary result
Transpulmonary gradient
Difference
0.2
95% CI −0.2 to 0.6
P = 0.21
By group
Low VT vs High VT
difference 0.2 (95% CI −0.2 to 0.6); P = 0.21
As reported in the abstract
Further findings
| Outcome | Low VT | High VT | Difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Peak inspiratory pressure | mean 15.3 (SD 2.9) cmH2O | mean 22.2 (SD 3.7) cmH2O | −6.9 (−7.8 to −5.9) | P < 0.001 | |
| Mean airway pressure | 7.3 (SD 0.8) | 8.7 (SD 0.9) | −1.5 (−2.1 to −0.8) | P = 0.001 | |
| Inspiratory timeMean, s | 0.62 (SD 0.22) | 1.21 (SD 0.55) | −0.59 (−0.84 to −0.34) | P < 0.001 | |
| Fontan pressureMean, mmHg | 13.3 (SD 1.8) | 12.3 (SD 2.5) | 0.8 (−0.5 to 2.1) | P = 0.18 | |
| −10−505Difference (linear scale) |
Transesophageal (TEE) pulmonary blood flow, stroke volume, Fontan flow
- No significant differences between low and high VT
Original publication
Hemodynamic Effects of Altering Tidal Volume During Positive Pressure Ventilation in the Fontan Circulation: A Randomized Crossover Trial. Paediatr Anaesth. Published 19 March 2025. doi:10.
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