Document Detail


Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery.
MedLine Citation:
PMID:  12059898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It is unclear whether positive end-expiratory pressure (PEEP) is needed to maintain the improved oxygenation and lung volume achieved after a lung recruitment maneuver in patients ventilated after cardiac surgery performed in the cardiopulmonary bypass (CPB). METHODS: A prospective, randomized, controlled study in a university hospital intensive care unit. Sixteen patients who had undergone cardiac surgery in CPB were studied during the recovery phase while still being mechanically ventilated with an inspired fraction of oxygen (FiO2) 1.0. Eight patients were randomized to lung recruitment (two 20-s inflations to 45 cmH2O), after which PEEP was set and kept for 2.5 h at 1 cmH2O above the pressure at the lower inflexion point (14+/-3 cmH2O, mean +/-SD) obtained from a static pressure-volume (PV) curve (PEEP group). The remaining eight patients were randomized to a recruitment maneuver only (ZEEP group). End-expiratory lung volume (EELV), series dead space, ventilation homogeneity, hemodynamics and PaO2 (oxygenation) were measured every 30 min during a 3-h period. PV curves were obtained at baseline, after 2.5 h, and in the PEEP group at 3 h. RESULTS: In the ZEEP group all measures were unchanged. In the PEEP group the EELV increased with 1220+/-254 ml (P<0.001) and PaO2 with 16+/-16 kPa (P<0.05) after lung recruitment. When PEEP was discontinued EELV decreased but PaO2 was maintained. The PV curve at 2.5 h coincided with the curve obtained at 3 h, and both curves were both steeper than and located above the baseline curve. CONCLUSIONS: Positive end-expiratory pressure is required after a lung recruitment maneuver in patients ventilated with high FiO2 after cardiac surgery to maintain lung volumes and the improved oxygenation.
Authors:
Thomas Dyhr; N Laursen; A Larsson
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  46     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-06-12     Completed Date:  2002-10-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  717-25     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Gentofte University Hospital, Denmark. thdy@gentoftehosp.kbhamt.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Gas Analysis
Cardiopulmonary Bypass*
Female
Heart Diseases / physiopathology*,  surgery
Hemodynamics / physiology
Humans
Lung Compliance / physiology
Lung Volume Measurements
Male
Middle Aged
Positive-Pressure Respiration*
Prospective Studies
Pulmonary Alveoli / physiology*
Pulmonary Ventilation / physiology*
Respiration, Artificial*
Respiratory Mechanics / physiology*
Tidal Volume / physiology
Total Lung Capacity / physiology*

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


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