Influence of a vital capacity maneuver on pulmonary gas exchange after cardiopulmonary bypass

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• 作者：Glenn S Murphy ; Joseph W Szokol ; Ronald D Curran ; Timothy V Votapka ; Jeffery S Vender
• 关键词：vital capacity maneuver ; cardiopulmonary bypass ; intrapulmonary shunt ; arterial oxygenation
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2001
• 出版时间：June 2001
• 年：2001
• 卷：15
• 期：3
• 页码：336-340
• 全文大小：56 K

文摘

Objective: To investigate the effect of a single, vital capacity breath (vital capacity maneuver [VCM]), administered at the end of cardiopulmonary bypass (CPB), on pulmonary gas exchange in patients undergoing coronary artery bypass graft surgery. Design: Prospective, randomized, double-blind study. Setting: University-affiliated hospital. Participants: Forty patients scheduled for elective coronary artery bypass graft surgery and early tracheal extubation. Interventions: Patients were randomized to 1 of 2 groups. VCM patients received a VCM at the conclusion of CPB. Control patients received no VCM. Measurements and Main Results: Intrapulmonary shunt (Q_S/Q_T), arterial oxygenation (PaO₂), and alveolar-arterial oxygen gradients (P(A-a)O₂) were measured after induction of anesthesia, CPB, intensive care unit (ICU) arrival, and extubation. The duration of postoperative intubation was recorded for each group. Q_S/Q_T increased significantly 30 minutes after CPB in the control group (15.7 ± 1.8 % to 27.4 ± 2.6 % ; p = 0.01). In the VCM group, a small decrease in Q_S/Q_T occurred (16.1 ± 2.0 % to 14.9 ± 2.0 % ). After ICU arrival and extubation, no significant difference in Q_S/Q_T existed between the 2 groups. With the exception of a higher P(A-a)O₂ in the control group at induction of anesthesia, no differences in PaO₂ or P(A-a)O₂ were present between the 2 groups at any measurement interval. Patients who received a VCM were extubated earlier than the control group (6.5 ± 2.1 hours v 9.4 ± 4.2 hours; p = 0.01). Conclusion: The use of a VCM prevented an increase in Q_S/Q_T from occurring in the operating room. Although a VCM did not influence pulmonary gas exchange in the ICU, its application in the operating room appears to exert a beneficial effect on tracheal extubation times after cardiac surgery. Copyright © 2001 by W.B. Saunders Company