Document Detail


The open lung concept: effects on right ventricular afterload after cardiac surgery.
MedLine Citation:
PMID:  15247107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The open lung concept (OLC) is a method of ventilation intended to maintain end-expiratory lung volume by increased airway pressure. Since this could increase right ventricular afterload, we studied the effect of this method on right ventricular afterload in patients after cardiac surgery. METHODS: We studied 24 stable patients after coronary artery surgery and/or valve surgery with cardiopulmonary bypass. Patients were randomly assigned to OLC or conventional mechanical ventilation (CMV). In the OLC group, recruitment manoeuvres were applied until Pa(o(2))/FI(O(2)) was greater than 50 kPa (reflecting an open lung). This value was maintained by sufficient positive airway pressure. In the CMV group, volume-controlled ventilation was used with a PEEP of 5 cm H(2)O. Cardiac index, right ventricular preload, contractility and afterload were measured with a pulmonary artery thermodilution catheter during the 3-h observation period. Blood gases were monitored continuously. RESULTS: To achieve Pa(O(2))/Fl(O(2)) > 50 kPa, 5.3 (3) (mean, SD) recruitment attempts were performed with a peak pressure of 45.5 (2) cm H(2)O. To keep the lung open, PEEP of 17.0 (3) cm H(2)O was required. Compared with baseline, pulmonary vascular resistance and right ventricular ejection fraction did not change significantly during the observation period in either group. CONCLUSION: No evidence was found that ventilation according to the OLC affects right ventricular afterload.
Authors:
D Reis Miranda; D Gommers; A Struijs; H Meeder; R Schepp; W Hop; A Bogers; J Klein; B Lachmann
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2004-07-09
Journal Detail:
Title:  British journal of anaesthesia     Volume:  93     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-12     Completed Date:  2004-09-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  327-32     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carbon Dioxide / blood
Cardiac Surgical Procedures*
Cardiopulmonary Bypass
Female
Hemodynamics
Humans
Male
Middle Aged
Oxygen / blood
Partial Pressure
Positive-Pressure Respiration / methods*
Postoperative Care / methods*
Prospective Studies
Stroke Volume
Ventricular Function, Right*
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

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


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