Swartz, Michael F.;
Makhija, Pooja;
Rubenstein, Jeffrey;
Henrichs, Kelly F.;
Powers, Karen S.;
Wang, Hong Yue;
Simon, Bartholomew V.;
Alfieris, George M.;
Blumberg, Neil;
Cholette, Jill M.
Met-Hemoglobin Is a Biomarker for Poor Oxygen Delivery in Infants Following Surgical Palliation
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Media type:
E-Article
Title:
Met-Hemoglobin Is a Biomarker for Poor Oxygen Delivery in Infants Following Surgical Palliation
Contributor:
Swartz, Michael F.;
Makhija, Pooja;
Rubenstein, Jeffrey;
Henrichs, Kelly F.;
Powers, Karen S.;
Wang, Hong Yue;
Simon, Bartholomew V.;
Alfieris, George M.;
Blumberg, Neil;
Cholette, Jill M.
Published:
SAGE Publications, 2019
Published in:
World Journal for Pediatric and Congenital Heart Surgery, 10 (2019) 4, Seite 485-491
Description:
Background:Infants with cyanotic congenital heart disease demonstrate wide fluctuations in hemoglobin (Hb), oxygen saturation, and cardiac output following palliation. Methemoglobin (Met-Hb), the product of Hb oxidation, may represent a compensatory mechanism during hypoxia and may be utilized as a biomarker.Methods:Arterial and venous Met-Hb levels were obtained from infants requiring palliation. The primary outcome was to describe the relationship between Met-Hb and other indices of tissue oxygenation (venous saturation, estimated arteriovenous oxygen difference [Est AV-Diff], and lactate). Secondary outcomes were to determine the impact of elevated Met-Hb levels ≥1.0% and the effect of red blood cell (RBC) transfusion on Met-Hb levels.Results:Fifty infants and 465 Met-Hb values were studied. Venous Met-Hb levels were significantly higher than arterial levels (venous: 0.84% ± 0.36% vs arterial: 0.45% ± 0.18%; P < .001). Venous Met-Hb demonstrated a significant inverse relationship with venous oxygen saturation ( R = −0.6; P < .001) and Hb ( R = −0.3, P < .001) and a direct relationship with the Est AV-Diff ( R = 0.3, P < .001). A total of 129 (29.6%) venous Met-Hb values were elevated (≥1.0%) and were associated with significantly lower Hb and venous saturation levels and higher Est AV-Diff and lactate levels. Methemoglobin levels decreased significantly following 65 RBC transfusions (0.94 ± 0.40 vs 0.77 ± 0.34; P < .001). Linear mixed models demonstrated that higher venous Met-Hb levels were associated with lower measures of tissue oxygenation and not related to any preoperative clinical differences.Conclusion:Methemoglobin may be a clinically useful marker of tissue oxygenation in infants following surgical palliation.