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.

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.

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 Effects of individualized positive end-expiratory pressure combined with recruitment maneuver on intraoperative ventilation during abdominal surgery: a systematic review and network meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Xiang Li ◽  
Zhi-Lin Ni ◽  
Jun Wang ◽  
Xiu-Cheng Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Recruitment Maneuver ◽  
Meta Analysis ◽  
Oxygenation Index ◽  
Dynamic Compliance ◽  
Ventilation Strategy ◽  
Positive End Expiratory Pressure ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Secondary Outcomes

AbstractLow tidal volume ventilation strategy may lead to atelectasis without proper positive end-expiratory pressure (PEEP) and recruitment maneuver (RM) settings. RM followed by individualized PEEP was a new method to optimize the intraoperative pulmonary function. We conducted a systematic review and network meta-analysis of randomized clinical trials to compare the effects of individualized PEEP + RM on intraoperative pulmonary function and hemodynamic with other PEEP and RM settings. The primary outcomes were intraoperative oxygenation index and dynamic compliance, while the secondary outcomes were intraoperative heart rate and mean arterial pressure. In total, we identified 15 clinical trials containing 36 randomized groups with 3634 participants. Ventilation strategies were divided into eight groups by four PEEP (L: low, M: moderate, H: high, and I: individualized) and two RM (yes or no) settings. The main results showed that IPEEP + RM group was superior to all other groups regarding to both oxygenation index and dynamic compliance. LPEEP group was inferior to LPEEP + RM, MPEEP, MPEEP + RM, and IPEEP + RM in terms of oxygenation index and LPEEP + RM, MPEEP, MPEEP + RM, HPEEP + RM, IPEEP, and IPEEP + RM in terms of dynamic compliance. All comparisons were similar for secondary outcomes. Our analysis suggested that individualized PEEP and RM may be the optimal low tidal volume ventilation strategy at present, while low PEEP without RM is not suggested.

scholarly journals Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
yirong zheng ◽  
wenpeng xie ◽  
jianfeng liu ◽  
ning xu ◽  
hua cao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Septal Defect ◽  
Positive Airway Pressure ◽  
Extubation Failure ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Failure Rates ◽  
Bilevel Positive Airway Pressure

Abstract Objective: To evaluate the effect of bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) in respiratory support after extubation in infants undergoing cardiac surgery. Methods: A total of 83 infants who underwent repair of atrial septal defect (ASD) or ventricular septal defect (VSD) after extubation were randomized to the BiPAP group (n= 42) or the NCPAP group (n= 41) between January 2020 and December 2020. The primary outcomes were the extubation failure rate and the level of PCO2 within 24 h after extubation. Results: The baseline characteristics between the two groups were similar. The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates compared to NCPAP (P>0.05). The PaCO2 level within 48 h was significantly lower in the BiPAP group (P<0.05). Additionally, the PaO2/FiO2 in the BiPAP group was significantly higher than that in the NCPAP group at 6h, 12h and 24h after treatment (P<0.05).There were no statistically significant differences in duaration on NIV, hospital length of stay, total hospital costs in $ and complications between the two groups (P>0.05). Conclusion: The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates versus NCPAP. However, BiPAP was shown to be superior to NCPAP in improving oxygenation and carbon dioxide clearance.

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