Cardiac Compression of Lung Lower Lobes after Coronary Artery Bypass Graft with Cardiopulmonary Bypass

Neves, Flávio; Carmona, Maria José Carvalho; Auler, José Otávio Costa; Rodrigues, Roseny R.; Rouby, Jean‐Jacques; Malbouisson, Luíz Marcelo Sá

doi:10.1371/journal.pone.0078643

Cited by 14 publications

(11 citation statements)

References 42 publications

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“…At the pulmonary level, cardiac surgery is related to increased permeability of the alveolo-capillary barrier [ 11 , 12 ] and mucociliary dysfunction [ 13 ]. Pulmonary atelectasis is very common in this context, [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

Lagier¹,

Fischer²,

Fornier³

et al. 2018

Trials

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BackgroundPostoperative pulmonary complications (PPCs) are frequent after on-pump cardiac surgery. Cardiac surgery results in a complex pulmonary insult leading to high susceptibility to perioperative pulmonary atelectasis. For technical reasons, ventilator settings interact with the surgical procedure and traditionally, low levels of positive end-expiratory pressure (PEEP) have been used. The objective is to compare a perioperative, multimodal and surgeon-controlled open-lung approach with conventional protective ventilation with low PEEP to prevent PPCs in patients undergoing cardiac surgery.Methods/designThe perioperative open-lung protective ventilation in cardiac surgery (PROVECS) trial is a multicenter, two-arm, randomized controlled trial. In total, 494 patients scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB) and aortic cross-clamp will be randomized into one of the two treatment arms. In the experimental group, systematic recruitment maneuvers and perioperative high PEEP (8 cmH2O) are associated with ultra-protective ventilation during CPB. In this group, the settings of the ventilator are controlled by surgeons in relation to standardized protocol deviations. In the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O) and continuous positive airway pressure during CPB (2 cmH2O) are used. Low tidal volumes (6–8 mL/kg of predicted body weight) are used before and after CPB in each group. The primary endpoint is a composite of the single PPCs evaluated during the first 7 postoperative days.DiscussionThe PROVECS trial will be the first multicenter randomized controlled trial to evaluate the impact of a perioperative and multimodal open-lung ventilatory strategy on the occurrence of PPCs after on-pump cardiac surgery. The trial design includes standardized surgeon-controlled protocol deviations that guarantee a pragmatic approach. The results will help anesthesiologists and surgeons aiming to optimize ventilatory settings during cardiac surgery.Trial registrationClinical Trials.gov, NCT 02866578. Registered on 15 August 2016. Last updated 11 July 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2967-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

Lagier¹,

Fischer²,

Fornier³

et al. 2018

Trials

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show abstract

“…Accumulated secretion, suppressed ciliary activity, general anesthesia, sedation, and surfactant changes might play roles in atelectasis development (Hanözü, 2006). Pulmonary collapse starts with anesthesia and continues for a few days in the post-operative period (Neves et al, 2013). The lungs are not perfused during a cardiopulmonary bypass, which causes a decrease in functional residual capacity.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Breathing Exercises on Preventing Postoperative Atelectasis: A Randomized Controlled Trial

Devecel¹,

Şenturan²

2018

FNJN

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Aim: This study aims to assess the effect of pre-operative breathing exercises provided to patients undergoing open-heart operation on atelectasis development during the post-operative period. Method: This randomized controlled study was conducted with 48 patients hospitalized for open-heart surgery. Training was provided to the patients in the experimental group in the form of breathing exercises and spirometry and the instructed exercises were performed by the patients for 7 days before the operation. The patients in both groups were assessed in terms of atelectasis during post-operative days. Results: The proportion of atelectasis development on the post-op 0th day was 71% in the experimental group and 92% in the control group. In terms of average peripheral oxygen saturation, the patients in the experimental group had higher oxygen saturation than the patients in the control group (p<0.05). Conclusion: Though not at significant levels, this study found that, performing breathing exercises before the operation decreased atelectasis development, duration of extubation, length of time in intensive care and hospital discharge; thus, pre-operative breathing exercises were found to have a positive effect on patients during the post-operative period.

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“…Neves et al. [12] studied the effect of increased heart weight in 17 patients undergoing coronary artery bypass grafting. Post-surgical edema and other mechanisms caused an average 32% increase in post-surgical heart weight.…”

Section: Discussionmentioning

confidence: 99%

Trapped lung secondary to cardiomegaly in a 78 year-old male with congestive heart failure

Amabile

Moffatt-Bruce

DePhilip

2016

Respiratory Medicine Case Reports

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Although the etiologies of both trapped lung and cardiomegaly are well-established, co-presentation of the two conditions, and possible interactions between them, are much rarer. Here we describe the case of 78 year-old male found to have both cardiomegaly and trapped lung, with a cause of death of congestive heart failure and subsequent cardiac arrest. This case prompted consideration of possible interactions between the two conditions. Issues related to decision-making for imaging and clinical interventions are also discussed.

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Cardiac Compression of Lung Lower Lobes after Coronary Artery Bypass Graft with Cardiopulmonary Bypass

Cited by 14 publications

References 42 publications

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

The Effect of Breathing Exercises on Preventing Postoperative Atelectasis: A Randomized Controlled Trial

Trapped lung secondary to cardiomegaly in a 78 year-old male with congestive heart failure

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