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Pre- & Post-Ductal
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Your patient becomes agitated. Their pre: 96% and post sat drops into the 80s. Why?
Right-to-left shunting through the PDA. PVR rises= pressure in the PA > the pressure in Aorta
What happens if the PDA closes in a systemic lesion?
Shock, acidosis, weak pulses, cool extremities.... bad things
In a ductal-dependent pulmonary lesion, is pre- or post- ductal sat usually lower?
Often both are low -- equal cyanosis
For a pt w/ pulmonary atresia, what clinical signs appear first if the duct starts to close?
Rapid desaturation and worsening cyanosis
Pre 85%, Post: 92% -- what's happening here?
Reverse differential cyanosis. Oxygenated blood is reaching the lower body but not the upper body/brain
Pre: 97% and post: 87% -- what type of shunt?
Right-to-left through the ductus. Blood bypasses the lungs --> lowers post ductal sats.
What does the foot probe tell you?
Post-ductal oxygenation -- blood after ductal mixing to the body.
What does the right-hand probe tell you?
pre-ductal oxygenation -- blood going to the brain.
What is a ductal-dependent systemic lesion?
A defect where blood can't reach the body without the PDA. Blood flows from PA--> PDA--> Aorta--> systemic circulation
What drug keeps the ductus open?
Prostaglandin E1 (PGE)
What is a ductal-dependent pulmonary lesion?
A defect where blood cannot reach the lungs without a PDA. The PDA must stay open to let blood flow from the aorta into the PA's
When do babies need the PDA to stay open? (think blood flow not specific defect)
When it provides critical pulmonary circulation or systemic circulation - depends on defect
Where are pre- and post- ductal probes placed?
Pre= right hand and post= either foot. Right hand = flow to brain, feet= lower body
Why is it concerning when pre-and post-ductal saturations differ by more than 10% in ductal dependent systemic circulatiom?
It means the difference in DO2 to the upper & lower body is ↑ : PH/high PVR, restrictive/closing pda (systemic), flow to lungs < systemic
Why do we check both pre- and post-ductal saturations in cardiac babies?
To detect shunting across the ductus arteriosus and see if there's a difference in oxygen delivery to the upper vs lower body
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