Effects of Alveolar Recruitment on Arterial Oxygenation in Patients After Cardiac Surgery: A Prospective, Randomized, Controlled Clinical Trial

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

“…Moreover, Tschernko et al showed that even with TVCM the shunt returned to control values after extubation (10.7 ± 4.3 at the end of surgery to 24.4 ± 8.5% after extubation) [15]. In contrast, Minkovich et al found in a recent randomized controlled trial that two recruitment manoeuvres: the first applied at the end of surgery before CPB separation and the second on arrival to the ICU, can maintain the benefits on oxygenation ratio extending from the immediate post-operative period to approximately 24 hours after surgery at the time of ICU discharge [26]. No additional benefit is found in our study by repeating recruitment manoeuvre in valvular replacement surgery if done after a well-executed standard recruitment manoeuvre (SRM) applied before CPB termination.…”

“…Increased Qs/Qt is a well-documented and undesirable phenomenon after CPB in cardiac surgery patients [5,11,13,14,16,26,30]. The effects of pulmonary atelectasis during CPB on post-CPB shunting and oxygenation is well demonstrated in animals and humans and is seen especially at the end of the surgery [11,15.26].…”

“…The recruitment manoeuvre using the vital capacity manoeuvre (TVCM) performed before the end of bypass was effective in preventing VC0 = Baseline ; VC12= 12 hours after extubation ; VC24 = 24 hours after extubation ; VC36 = 36 hours after extubation ; VC48 = 48 hours after extubation ; VC discharge = Discharge from the hospital post-operative impairment in gas exchange [15,18,26,28,32]. In fact, Rothen et al recently proved that this manoeuvre needs to be maintained for 8 seconds only to allow a re-expansion of packed pulmonary tissue and was not necessary for 15 seconds as described previously [33].…”

“…In recent years at the end of cardiopulmonary bypass (CPB) surgery and before patient extubation, alveolar recruitment manoeuvres were shown to have some benefit on post-surgical hypoxia and allowed an earlier extubation in the treated group [5,15,18,22,[26][27][28]. The total vital capacity manoeuvre (TVCM) is standardized and is the most commonly used.…”

“…The studies were restricted by the limited number of patients and short term benefits gained [5,15,27,28]. Minkovich et Coll showed that two consecutive recruitment manoeuvres result in a better arterial oxygenation extending from the immediate postoperative period to approximately 24 hours after surgery [26]. In a recent study, Leme et al demonstrated that the use of an intensive vs a moderate alveolar recruitment strategy resulted in less severe pulmonary complications [18].…”