Effect of low volume ventilation during cardiopulmonary bypass on oxygenation and postoperative pulmonary outcome
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- 作者：Chaitali Sen Dasgupta (1)
Sandeep Kumar Kar (1)
Anupam Goswami (1)
Santanu Dutta (2)
Uday Narayan Sarkar (2) - 关键词：Cardiopulmonary bypass ; Ventilation ; Pulmonary atelectasis
- 刊名：Indian Journal of Thoracic and Cardiovascular Surgery
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：28
- 期：4
- 页码：209-214
- 全文大小：557KB
- 参考文献：1. Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Hypothermia, circulatory arrest and cardiopulmonary bypass. Kirklin/Barratt-Boyes. Cardiac surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2003. p. 66-30.
2. Eppinger MJ, Ward PA, Jones ML, Bolling SF, Deeb GM. Disparate effects of nitric oxide on lung ischemia-reperfusion injury. Ann Thorac Surg. 1995;60:1169-6. CrossRef
3. Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg. 1999;68:1107-5. CrossRef
4. Magnusson L, Zemgulis V, Wicky S, Tydén H, Hedenstierna G. Effect of CPAP during cardiopulmonary bypass on postoperative lung function: an experimental study. Acta Anaesthesiol Scand. 1998;42:1133-. CrossRef
5. Tenling A, Hachenberg T, Tydén H, Wegenius G, Hedenstierna G. Atelectasis and gas exchange after cardiac surgery. Anesthesiology. 1998;89:371-. CrossRef
6. Berry CB, Butler PJ, Myles PS. Lung management during cardiopulmonary bypass: is continuous positive airway pressure beneficial? Br J Anaesth. 1993;71:864-. CrossRef
7. Boldt J, King D, Scheld HH, Hempelmann G. Lung management during cardiopulmonary bypass: influence on extravascular lung water. J Cardiothorac Anesth. 1990;4:73-. CrossRef
8. Ellis EL, Brown A, Osborn JJ, Gerbode F. Effect of altered ventilation patterns on compliance during cardiopulmonary bypass. Anesth Analg. 1969;48:947-2. CrossRef
9. Chai PJ, Williamson JA, Lodge AJ, et al. Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass. Ann Thorac Surg. 1999;67:731-. CrossRef
10. Ghia J, Andersen NB. Pulmonary function and cardiopulmonary bypass. JAMA. 1970;212:593-. CrossRef
11. Hewson JR, Shaw M. Continuous airway pressure with oxygen minimizes the metabolic lesion of “pump lung- Can Anaesth Soc J. 1983;30:37-7. CrossRef
12. Zabeeda D, Gefen R, Medalion B, Khazin V, Shachner A, Ezri T. The effect of high-frequency ventilation of the lungs on postbypass oxygenation: a comparison with other ventilation methods applied during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2003;17:40-. CrossRef
13. Massoudy P, Piotrowski JA, van de Wal HC, et al. Perfusing and ventilating the patient’s lungs during bypass ameliorates the increase in extravascular thermal volume after coronary bypass grafting. Ann Thorac Surg. 2003;76:516-1. CrossRef
14. Shafique T, Johnson RG, Dai HB, Weintraub RM, Sellke FW. Altered pulmonary microvascular reactivity after total cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1993;106:479-6.
15. LoCicero 3rd J, McCann B, Massad M, Joob AW. Prolonged ventilatory support after open-heart surgery. Crit Care Med. 1992;20:990-. CrossRef
16. Lamarche Y, Gagnon J, Malo O, Blaise G, Carrier M, Perrault LP. Ventilation prevents pulmonary endothelial dysfunction and improves oxygenation after cardiopulmonary bypass without aortic cross- clamping. Eur J Cardiothorac Surg. 2004;26:554-3. CrossRef
17. Magnusson L, Zemgulis V, Tenling A, et al. Use of a vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass: an experimental study. Anesthesiology. 1998;88:134-2. CrossRef
18. Loeckinger A, Kleinsasser A, Lindner KH, Margreiter J, Keller C, Hoermann C. Continuous positive airway pressure at 10?cm H2O during cardiopulmonary bypass improves postoperative gas exchange. Anesth Analg. 2000;91:522-. CrossRef
19. Bayindir O, Akpinar B, Ozbek U, et al. The hazardous effects of alveolar hypocapnia on lung mechanics during weaning from cardiopulmonary bypass. Perfusion. 2000;15:27-1. CrossRef
20. Sasson L, Sherman A, Ezri T, et al. Mode of ventilation during cardiopulmonary bypass does not affect immediate postbypass oxygenation in pediatric cardiac patients. J Clin Anesth. 2007;19:429-3. CrossRef
21. Huang P, Zhou WW, Liu PB. Effects of mechanical ventilation on plasma IL-6, IL-10 and TNF-alpha in children after cardiopulmonary bypass. Zhongguo Dang Dai Er Ke Za Zhi. 2008;10:708-0.
22. Gagnon J, Laporta D, Beique F, Langlois Y, Morin JF. Clinical relevance of ventilation during cardiopulmonary bypass in the prevention of postoperative lung dysfunction. Perfusion. 2010;25:205-0. CrossRef
23. Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O. What tidal volumes should be used in patients without acute lung injury? Anesthesiology. 2007;106:1226-1. CrossRef
24. Hans GA, Sottiaux TM, Lamy ML, Joris JL. Ventilatory management during routine general anaesthesia. Eur J Anaesthesiol. 2009;26:1-. CrossRef
25. Ochs M, Nyengaard JR, Jung A, et al. The number of alveoli in the human lung. Am J Respir Crit Care Med. 2004;169:120-. CrossRef
26. Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80?years and older. Ann Thorac Surg. 1997;64:606-5. CrossRef - 作者单位：Chaitali Sen Dasgupta (1)
Sandeep Kumar Kar (1)
Anupam Goswami (1)
Santanu Dutta (2)
Uday Narayan Sarkar (2)
1. Department of Cardiac Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, India
2. Department of Cardiothoracic and Vascular Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, India
文摘
Objective This study was carried out to evaluate effect of low volume normal frequency ventilation during Cardiopulmonary Bypass (CPB) on immediate postoperative respiratory outcome in patients undergoing elective open heart surgeries. Background Lung deflation during CPB is considered as major cause of postoperative pulmonary dysfunction. Various methods of ventilation had been tried during CPB to prevent postoperative lung dysfunction. As yet, little information is available comparing low volume normal frequency ventilation with no ventilation during CPB. Patients and Methods Thirty six patients aged 18?years to 65?years were included and randomized into two groups; Group V (n--8) or Group NV (n--8). Group V patients were ventilated with a tidal volume of 2?mL?kg?with 100?% oxygen during CPB after aortic clamp placement, and respiratory rate was continued as per pre CPB period. Ventilation was discontinued in NV group after aorta was cross clamped. Normal ventilation was restored in both groups after release of aortic clamp. Results Intraoperative PaO2 and PaCO2 were similar in both groups. The group V patients had improved inspiratory capacity (p--.0) in both day 1 (after extubation) and day 2 (24?h after extubation). Extubation was significantly earlier in group V patients (p-lt;-.05). Conclusion Low volume normal frequency ventilation during cardiopulmonary bypass improves lung mechanics during early postoperative period in patients undergoing open heart surgery.