Document Detail


Recruitment maneuver and high positive end-expiratory pressure improve hypoxemia in patients after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism.
MedLine Citation:
PMID:  16148473     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To investigate the effects of a recruitment maneuver and high positive end-expiratory pressure (PEEP) on oxygenation and hemodynamics in hypoxemic patients with pulmonary hypertension after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. DESIGN: Prospective, observational, clinical study. SETTING: A surgical intensive care unit in a national heart institute. PATIENTS: Fourteen consecutively admitted patients who developed acute lung injury (Pa(O2) <300 torr at F(IO2) 1.0) and pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. INTERVENTIONS: The recruitment maneuver was an increase of PEEP to 30 cm H2O in one step for 1 min at F(IO2) 1.0. The level of pressure control ventilation during the recruitment maneuver was the same as before the maneuver. Subsequently, PEEP was decreased in 15-min intervals from 15 to 10, 5, and 0 cm H2O. MEASUREMENTS AND MAIN RESULTS: Hemodynamics and respiratory variables were analyzed before and during the recruitment maneuver and at each PEEP level. At F(IO2) 1.0, Pa(O2) increased from 240 +/- 62 torr to 470 +/- 83 torr at 15 cm H2O of PEEP and 469 +/- 75 torr at 10 cm H2O of PEEP after the recruitment maneuver (p < .001). At 15 cm H2O of PEEP, cardiac index decreased (from 2.7 +/- 0.6 at baseline to 2.2 +/- 0.3 L.min(-1).m(-2), p < .01) and mean blood pressure decreased (from 86 +/- 8 at baseline to 74 +/- 11 mm Hg, p < .05), but they returned to the baseline levels at 10 cm H2O of PEEP (2.5 +/- 0.4 L.min(-1).m(-2) and 83 +/- 9 mm Hg). There were no differences in mean pulmonary artery pressure at different levels of PEEP. CONCLUSIONS: In hypoxemic patients with pulmonary hypertension after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, oxygenation was improved by the recruitment maneuver followed by high PEEP. However, hemodynamics were transiently suppressed and overall oxygen delivery did not change.
Authors:
Muneyuki Takeuchi; Hideaki Imanaka; Kazuya Tachibana; Hitoshi Ogino; Motomi Ando; Masaji Nishimura
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-08     Completed Date:  2005-11-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2010-4     Citation Subset:  AIM; IM    
Affiliation:
Surgical Intensive Care Unit, National Cardiovascular Center, Suita, Osaka, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anoxia / etiology,  therapy*
Blood Pressure / physiology
Chronic Disease
Endarterectomy*
Female
Humans
Hypertension, Pulmonary / complications
Male
Middle Aged
Oxygen Consumption / physiology
Positive-Pressure Respiration*
Postoperative Complications / therapy
Prospective Studies
Pulmonary Embolism / surgery*
Comments/Corrections
Comment In:
Crit Care Med. 2005 Sep;33(9):2132-3   [PMID:  16148499 ]

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


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