Lung Management During Cardiopulmonary Bypass: Is Continuous Positive Airways Pressure Beneficial?

Abstract

It is not clear if the use of continuous positive airway pressure (CPAP) during cardiopulmonary bypass (CPB) improves lung function after cardiac surgery. We have measured alveolar-arterial oxygen partial pressure difference (PAO2-PaO2) in 61 patients undergoing elective coronary artery bypass surgery. We studied three groups of patients: in group 1 the lungs were disconnected from the breathing system (no CPAP) during CPB; in group 2, 5 cm H2O CPAP with air was applied to the lungs; in group 3, 5 cm H2O of CPAP was applied with 100% oxygen. (PAO2-PaO2) was measured before CPB and then at 30 min, 4 h and 8 h after CPB. Compared with group 1 (no CPAP), (PAO2-PaO2) was significantly smaller in groups 2 and 3 at 30 min (P = 0.036), but not at 4 h and 8 h after CPB (P = 0.32, P = 0.96). The time to extubation (P = 0.42) and early extubation (P = 0.87) were not affected by the use of CPAP. The results of this study do not support the use of CPAP during CPB as a mechanism of improving lung function after cardiac surgery.

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

“…Increased CI as well as decreased SVRI in patients undergoing cardiac surgery with extracorporal circulation are comparable to the findings in other studies, and can have two explanations [15,38,39]. Firstly, the correction of valvular dysfunction plays a major role in the amelioration of cardiac performance and hence stroke volume.…”

“…Berry et al found that PEEP applied during surgery didn't succeed to modify the extubation time [38]. In our study, extubation times in both groups were not statistically significant with RRM group (8.8 ± 4.4 hours) and SC group (10.4 ± 4.3 hours) respectively.…”

Torasik cerrahi sonrası postoperatif pulmoner komplikasyonların önlenmesinde İnsentif spirometre ve Continous Positive Airway Pressure (CPAP)'ın karşılaştırılması

“…Her iki grup arasında demografik özellikler açısından istatistiksel olarak farklılık bulunmadı. Hastaların ortalama yoğun bakım kalış süresi iki gün (1-7), hastane kalış süresi ortalama sekiz gün (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Komplikasyonlar: İS grubundaki hastalarda postoperatif birinci gün, iki hastada lober atelektazi, bir hastada segmental atelektazi, dört hastada ise plevral efüzyon görüldü (Tablo 6). CPAP grubundaki hastalarda, postoperatif birinci gün üç hastada lober atelektazi, bir hastada ise plevral efüzyon görüldü.…”

“…Solunum fonksiyon testleri parametrelerinde gerçekleşen bu azalmaları düzeltmek ve ciddi sağlık problemlerine yol açabilen bu komplikasyonların önlenmesi için çeşitli fizyoterapi yöntemlerini kullanan farklı çalışmalar yapılmıştır. [8][9][10] Postoperatif pulmoner komplikasyonların önlenmesinde pek çok fizyoterapi yaklaşımı söz konusudur. Bunlar; ekspiratuar manevralar, IPPB, aktif solunum teknikleri döngüsü, İS, CPAP, PEP (Positive Expiratory Pressure) gibi yöntemlerdir.…”

CPAP at 10 cm H2O during cardiopulmonary bypass does not improve postoperative gas exchange

“…The incidence of pulmonary complications varied largely and has been reported in 2% to 64% in patients submitted to open heart surgery with CPB, being characterized by an increase in the alveolar-arterial oxygen gradient [P(A-a)O 2 ], atelectasis and increased alveolo-capilar membrane permeability [2].…”