This study will investigate the different tidal volume (Vt) strategies during a cardiac catheterization procedure to determine whether or not low or high Vt have an impact on cardiac output. Research question: While maintaining the same minute ventilation/PaCO2, does higher Vt (10 cc/kg)/lower rate vs. lower Vt (6 cc/kg)/higher rate (maintaining consistent PEEP) result in improved cardiac output?
The trial will be a randomized crossover design. The study cohort will be randomized (50/50) to begin with either low Vt or high Vt ventilation. After achieving steady state, initial cardiac output measurements will be made using a measured oxygen consumption (VO2) and the Fick principle, per routine clinical protocol. Following baseline assessment of cardiac output and hemodynamics (which is standard of care for all catheterization procedures), participants will be transitioned to the alternative ventilation modality (high Vt or low Vt). After a 5-minute equilibration period, oxygen saturations and VO2 measurements will be re-acquired, to determine cardiac output and hemodynamics in this second state.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
32
Low Vt protocol - tidal volumes (Vt) 6 ml/kg, respiratory rate required for end tidal carbon dioxide (EtCO2) of 36-38 mmHg, PEEP 5 centimeter of water (cm-H20) , I:E ratio 1:2
High Vt protocol - tidal volumes (Vt) 10 ml/kg, respiratory rate required for EtCO2 of 36-38 mm Hg, PEEP 5 cmH2O, I:E ratio 1:3.
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
Cardiac Output
The investigators will assess cardiac output using the Fink principle for each arm of randomization.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
Pulmonary blood flow
The investigators will compare blood flow in both arms.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
Systemic blood pressure
The investigators will assess the vital sign in both intervention arms.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
Pulmonary arterial pressure
The investigators will assess pressures in both intervention arms.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
Pulmonary vascular resistance
Completed using pulmonary vascular resistance (PVR) equation from measurements obtained during the cardiac catheterization.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
Systemic vascular resistance
This will be calculated using appropriate equations using measurement obtained during catheterization procedure.
Time frame: Measurements will occur at the 5-minute equilibration period into the ventilation strategy.
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