Document Detail


Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass.
MedLine Citation:
PMID:  12562405     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Atelectasis occurs during general anaesthesia. This is partly responsible for the impairment of gas exchange that occurs peri-operatively. During cardiopulmonary bypass, this atelectasis is exacerbated by the physical collapse of the lungs. As a result, poor arterial oxygenation is often seen postoperatively. We tested the effect of an 'alveolar recruitment strategy' on arterial oxygenation in a prospective randomised study of 78 patients undergoing cardiopulmonary bypass. Patients were divided equally into three groups of 26. Group 'no PEEP' received a standard post bypass manual lung inflation, and no positive end-expiratory pressure was applied until arrival at intensive care unit. Group '5 PEEP' received a standard post bypass manual inflation, and then 5 cmH2O of positive end-expiratory pressure was applied and maintained until extubation on intensive care. The third group, 'recruitment group', received a pressure-controlled stepwise increase in positive end-expiratory pressure up to 15 cmH2O and tidal volumes of up to 18 ml x kg(-1) until a peak inspiratory pressure of 40 cmH2O was reached. This was maintained for 10 cycles; the positive end-expiratory pressure of 5 cmH2O was maintained until extubation on intensive care. There was a significantly better oxygenation in the recruitment group at 30 min and 1 h post bypass when compared with the no PEEP and 5 PEEP groups. There was no significant difference in any of the groups beyond 1 h. Application of 5 cmH2O positive end-expiratory pressure alone had no significant effect on oxygenation. No complications due to the alveolar recruitment manoeuvre occurred. We conclude that the application of an alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass surgery.
Authors:
B A Claxton; P Morgan; H McKeague; A Mulpur; J Berridge
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anaesthesia     Volume:  58     ISSN:  0003-2409     ISO Abbreviation:  Anaesthesia     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-03     Completed Date:  2003-03-25     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  England    
Other Details:
Languages:  eng     Pagination:  111-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthesia, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, General / adverse effects
Cardiopulmonary Bypass / adverse effects*
Female
Humans
Male
Middle Aged
Monitoring, Physiologic
Oxygen / blood*
Partial Pressure
Positive-Pressure Respiration / methods*
Postoperative Care / methods*
Postoperative Period
Prospective Studies
Pulmonary Atelectasis / etiology,  prevention & control*
Chemical
Reg. No./Substance:
7782-44-7/Oxygen
Comments/Corrections
Comment In:
Anaesthesia. 2003 Aug;58(8):809; author reply 809   [PMID:  12859486 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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