Document Detail


Comparison of the lower inflection point on the static total respiratory compliance curve with outcomes in postoperative cardiothoracic patients.
MedLine Citation:
PMID:  11688607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Routine use of positive end-expiratory pressure (based on the pressure at the lower inflection point on the static total respiratory compliance curve) along with a maneuver to recruit atelectatic lung has been advocated after cardiothoracic surgery. OBJECTIVES: To determine if the lower inflection point is related to outcomes in patients after sternotomy and cardiopulmonary bypass. METHOD: A prospective observational study involving estimation of the lower inflection point on the inflation pressure-volume plot obtained with a low-flow technique. Duration of intubation, length of stay, respiratory complications, and results of spirometry were compared between patients with a "high " inflection point (> or =10 cm H2O) and patients with a "low" inflection point (< or =5 cm H2O). RESULTS: Ninety-five patients were enrolled. After exclusion for incomplete data, 65 patients (49 men, 16 women; mean age, 66.1 years; SD, 9.5 years) were included. The mean lower inflection point was 6.33 cm H2O (SD, 3.4 cm H2O). A second lower inflection point was observed on 5 plots (mean, 21 cm H2O; SD, 1.4 cm H2O). Nine patients had high inflection points (mean, 13.1 cm H2O; SD, 3.0 cm H2O), and 33 had low inflection points (mean, 3.9 cm H2O; SD, 0.98 cm H2O). No outcome measures differed between groups. CONCLUSIONS: In patients with short intubation times and predictable postoperative course, general use of a lung recruitment strategy involving sustained inflations and adjustment of positive end-expiratory pressure based on the lower inflection point is difficult to justify.
Authors:
M Boyle; P Way; M Pinfold; J Lawrence
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of critical care : an official publication, American Association of Critical-Care Nurses     Volume:  10     ISSN:  1062-3264     ISO Abbreviation:  Am. J. Crit. Care     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-01     Completed Date:  2002-02-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9211547     Medline TA:  Am J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  399-407     Citation Subset:  IM; N    
Affiliation:
Prince of Wales Hospital, Randwick, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiopulmonary Bypass*
Cardiovascular Surgical Procedures*
Female
Humans
Lung Compliance*
Lung Volume Measurements
Male
Positive-Pressure Respiration*
Postoperative Care
Sternum / surgery*
Treatment Outcome

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


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