Effect of Lung Ventilation With 50% Oxygen in Air or Nitrous Oxide Versus 100% Oxygen on Oxygenation Index After Cardiopulmonary Bypass

2006 ◽  
Vol 20 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Prabhat Kumar Sinha ◽  
Praveen Kumar Neema ◽  
Koniparambil Pappu Unnikrishnan ◽  
Praveen Kerala Varma ◽  
Karunakaran Jaykumar ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Cardiopulmonary Bypass ◽  
Oxygenation Index ◽  
Lung Ventilation

scholarly journals Respiratory tactics during cardiopulmonary bypass in cardiac surgery

2021 ◽  
Vol 18 (2) ◽  
pp. 40-47
Author(s):  
A. Yu. Kirillov ◽  
A. G. Yavorovskiy ◽  
M. A. Vyzhigina ◽  
R. N. Komarov ◽  
P. V. Nogtev ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Positive Airway Pressure ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Respiratory Support ◽  
Favorable Effect ◽  
Positive End Expiratory Pressure ◽  
Important Place ◽  
Volume Ventilation

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

scholarly journals Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

2014 ◽  
Vol 3 ◽  
Author(s):  
Vladimir Pichugin ◽  
Nikolay Melnikov ◽  
Farkhad Olzhayev ◽  
Alexander Medvedev ◽  
Sergey Jourko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Lung Compliance ◽  
Beating Heart ◽  
Low Flow ◽  
Control Group ◽  
Coronary Perfusion ◽  
The Third

Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB) is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP) and the “beating heart” in combination with pulmonary artery perfusion (PAP) and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients), the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients), the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients), the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level), oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and  47.7%, respectively. 24 hours after surgery, CK-MB levels were lower in the second and third groups by 42.0% and  42.6%, respectively, and lower by 29.7% and 27.4% 48 hours after surgery, respectively. Normalization of CK-MB levels were registered earlier in second and third groups (within 24 hours) than the control group. Oxygenation index and lung compliance were significantly higher in the third group after CPB.Conclusion. Our technique improved myocardial and lung function in patients, but larger prospective randomized trials are needed to definitively assess the protective effects of this technique.

scholarly journals The Impact of Lung Ventilation on Some Cytokines after Coronary Artery Bypass Grafting

2016 ◽  
Vol 106 (1) ◽  
pp. 87-93 ◽  
Author(s):  
V. Toikkanen ◽  
T. Rinne ◽  
R. Nieminen ◽  
E. Moilanen ◽  
J. Laurikka ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Artery Bypass ◽  
Lung Ventilation ◽  
Interleukin 10 ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background and Aims: Cardiopulmonary bypass induces a systematic inflammatory response, which is partly understood by investigation of peripheral blood cytokine levels alone; the lungs may interfere with the net cytokine concentration. We investigated whether lung ventilation influences lung passage of some cytokines after coronary artery bypass grafting. Material and Methods: In total, 47 patients undergoing coronary artery bypass grafting were enrolled, and 37 were randomized according to the ventilation technique: (1) No-ventilation group, with intubation tube detached from the ventilator; (2) low tidal volume group, with continuous low tidal volume ventilation; and (3) continuous 10 cm H2O positive airway pressure. Ten selected patients undergoing surgery without cardiopulmonary bypass served as a referral group. Representative pulmonary and radial artery blood samples were collected for the evaluation of calculated lung passage (pulmonary/radial artery) of the pro-inflammatory cytokines (interleukin 6 and interleukin 8) and the anti-inflammatory interleukin 10 immediately after induction of anesthesia (T1), 1 h after restoring ventilation/return of flow in all grafts (T2), and 20 h after restoring ventilation/return of flow in all grafts (T3). Results: Pulmonary/radial artery interleukin 6 and pulmonary/radial artery interleukin 8 ratios ( p = 0.001 and p = 0.05, respectively) decreased, while pulmonary/radial artery interleukin 10 ratio ( p = 0.001) increased in patients without cardiopulmonary bypass as compared with patients with cardiopulmonary bypass. Conclusions: The pulmonary/radial artery equation is an innovative means for the evaluation of cytokine lung passage after coronary artery bypass grafting. The mode of lung ventilation has no impact on some cytokines after coronary artery bypass grafting in patients treated with cardiopulmonary bypass.

scholarly journals The fraction of Nitrous Oxide in oxygen for facilitating Lung collapse During One-Lung Ventilation with double lumen tube

2020 ◽  
Author(s):  
chao liang ◽  
Yuechang Lv ◽  
Yu Shi ◽  
Jing Cang ◽  
Zhanggang Xue
Keyword(s):  
Nitrous Oxide ◽  
Confidence Interval ◽  
Thoracoscopic Surgery ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Effective Concentration ◽  
Double Lumen Tube ◽  
Test Results ◽  
Lung Collapse ◽  
One Lung Ventilation

Abstract Backgroud To the best of our knowledge, it is still unclear what is the proper fraction of nitrous oxide(N 2 O) in oxygen(O 2 ) for fast lung collapse. Therefore, we designed this prospective trial to determine the 50% effective concentration (EC 50 ) and 95% effective concentration (EC 95 ) of N 2 O in O 2 for fast lung collapse. Methods We studied 38 consecutive patients undergoing video-assisted thoracoscopic surgery(VATS). The lung collapse score(LCS) of each patient during one lung ventilation was evaluated by the same surgeon. The first patient received 30% N 2 O in O 2 , and subsequent N 2 O fraction in O 2 was determined by the LCS of previous patient using Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10%, 20%, 30%, 40%, or 50%). The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were analyzed using probit test. Results The N 2 O fraction in O 2 at which all patients showed success lung collapse was 50%, according to the up-and-down method. The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% (95% confidence interval, 19.9%–35.7%) and 48.7% (95% confidence interval, 39.0%–96.3%), respectively. Conclusions In patients undergoing VATS, the EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% and 48.7%, respectively.

Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis

Perfusion ◽  
2008 ◽  
Vol 23 (6) ◽  
pp. 323-327 ◽  
Author(s):  
E Sirvinskas ◽  
J Andrejaitiene ◽  
L Raliene ◽  
L Nasvytis ◽  
A Karbonskiene ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Urine Output ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Lung Ventilation ◽  
Early Postoperative Period

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.

The Effects of Xenon or Nitrous Oxide Supplementation on Systemic Oxygenation and Pulmonary Perfusion During One-Lung Ventilation in Pigs

2005 ◽  
Vol 100 (2) ◽  
pp. 335-339 ◽  
Author(s):  
Konrad Schwarzkopf ◽  
Torsten Schreiber ◽  
Elke Gaser ◽  
Niels-Peter Preussler ◽  
Lars Hueter ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Lung Ventilation ◽  
Pulmonary Perfusion ◽  
One Lung Ventilation

Nitrous Oxide Method of Measuring Cerebral Blood Flow During Hypothermic Cardiopulmonary Bypass

1997 ◽  
Vol 63 (3) ◽  
pp. 736-740 ◽  
Author(s):  
Ian MacVeigh ◽  
David J Cook ◽  
Thomas A Orszulak ◽  
Richard C Daly ◽  
Dorothy E Munnikhuysen
Keyword(s):  
Blood Flow ◽  
Nitrous Oxide ◽  
Cerebral Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Hypothermic Cardiopulmonary Bypass

Effect of Therapeutic Hypercapnia on Inflammatory Responses to One-lung Ventilation in Lobectomy Patients

2015 ◽  
Vol 122 (6) ◽  
pp. 1235-1252 ◽  
Author(s):  
Wei Gao ◽  
Dong-Dong Liu ◽  
Di Li ◽  
Guang-xiao Cui
Keyword(s):  
Carbon Dioxide ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Inflammatory Responses ◽  
Oxygenation Index ◽  
Lung Ventilation ◽  
Lung Compliance ◽  
Carbon Dioxide Partial Pressure ◽  
One Lung Ventilation ◽  
Necrosis Factor

Abstract Background: One-lung ventilation (OLV) can result in local and systemic inflammation. This prospective, randomized trial was to evaluate the effect of therapeutic hypercapnia on lung injury after OLV. Method: Fifty patients aged 20 to 60 yr undergoing lobectomy were randomly provided with air or carbon dioxide (partial pressure of carbon dioxide: 35 to 45 mmHg or 60 to 70 mmHg). Peak pressure, plateau pressure, and lung compliance were recorded. Bronchoalveolar lavage fluid (BALF) and blood samples were collected. Adverse events were monitored. The primary outcome was the concentration of BALF tumor necrosis factor, and the secondary outcomes were serum cytokine concentrations. Results: The BALF tumor necrosis factor was lower in the carbon dioxide group than in the air group (median [range], 51.1 [42.8 to 76.6] vs. 71.2 [44.8 to 92.7]; P = 0.034). Patients in the carbon dioxide group had lower concentrations of serum and BALF interleukin (IL)-1, IL-6, and IL-8, but higher serum concentrations of IL-10, accompanied by reduced numbers of cells and neutrophils as well as lower concentrations of protein in the BALF. Also, patients in the carbon dioxide group had lower peak (mean ± SD, 22.2 ± 2.9 vs. 29.8 ± 4.6) and plateau pressures (20.5 ± 2.4 vs. 27.1 ± 2.9), but higher dynamic compliance (46.6 ± 5.8 vs. 38.9 ± 6.5). Furthermore, patients in the carbon dioxide group had higher postoperation oxygenation index values. Ten patients experienced slightly increased blood pressure and heart rate during OLV in the carbon dioxide group. Conclusion: Under intravenous anesthesia, therapeutic hypercapnia inhibits local and systematic inflammation and improves respiratory function after OLV in lobectomy patients without severe complications.

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