Hypoxic gas therapy using nitrogen in the preoperative management of neonates with hypoplastic left heart syndrome.

OBJECTIVE

To evaluate the efficacy of hypoxic gas therapy using nitrogen, where the fraction of inspired oxygen (Fio2) was reduced to <0.21 in patients with univentricular parallel circulation.

DESIGN

Case report.

SETTING

A pediatric intensive care unit at a university hospital. PATIENTS: Two neonatal patients with hypoplastic left heart syndrome admitted to the pediatric intensive care unit preoperatively. INTERVENTIONS: Nitrogen insufflation by using continuous-flow respiratory support. MEASUREMENTS AND MAIN

RESULTS

We reduced the Fio2 in these patients by giving additional nitrogen to relieve pulmonary overcirculation and systemic hypoperfusion suspected by transcutaneous arterial oxygen saturation >90%, systemic arterial hypotension, and low urine output in the preoperative course. The improvement of systemic hemodynamics concomitant with decreases in transcutaneous arterial oxygen saturation <85% was accomplished by controlling Fio2 between 0.14 and 0.18. These infants were able to undergo Norwood's surgery after several days without complications relating to Fio2 reduction.

CONCLUSION

Hypoxic gas therapy with nitrogen was effective clinically in preventing pulmonary overcirculation in neonatal patients with univentricular and parallel circulation.