Lung recruitment improves right ventricular performance after cardiopulmonary bypass

Longo, S.; Siri, Juan; Acosta, Cecilia; A, Palencia; Echegaray, Arturo; Chiotti, Iván; Parisi, A.; Ricci, Lorenzo; Natal, Marcela; Suárez-Sipmann, Fernando; Tusman, Gerardo

doi:10.1097/eja.0000000000000559

Cited by 23 publications

(21 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recruitment "responders" generally had an increase in aeration of non-aerated lung tissue of more than 20% (Figure 2). (Généreux et al, 2020) ZEEP (Bouhemad et al, 2011;Rode et al, 2012;Tang et al, 2017;Généreux et al, 2020), 6 cm H 2 O (Longo et al, 2017) 34 cm H 2 O [30][31][32][33][34][35][36][37][38][39][40] Maximum increase in regasification score (Tang et al, 2017) Disappearance of atelectasis or B-lines (Bouhemad et al, 2011;Rode et al, 2012;Longo et al, 2017) EIT Any decrease in ODCLindex (Karsten et al,…”

Section: Recruitment Methodology and Identification Of "Responders"mentioning

confidence: 99%

“…In two studies, there was a high concern regarding applicability of population selection. These two studies included a highly selective population, i.e., patients after cardiac surgery (Longo et al, 2017) or patients who underwent tracheostomy (Eichler et al, 2018).…”

Section: Included Studiesmentioning

confidence: 99%

“…Observed lung re-aeration with imaging analysis LUS 8% of evaluated consolidations did not respond to RM (Rode et al, 2012) No change of LUS score after RM (Généreux et al, 2020) 27% of patients had a re-aeration score ≥8 and an increase in lung volume more than 600 ml after RM (Bouhemad et al, 2011) 10% of patients do not respond to RM (Longo et al, 2017) EIT Extremely high variability in changes of the ratio between overdistention and collapsed ration (He et al, 2020) Variable* compromise between the extension of lung collapse and overdistention after RM (Karsten et al, 2019) CT High variability* of potential recruitment tissue (Caironi et al, 2015) Potential recruitable tissue: 45% (range 5-75%; de Matos et al, 2012) Potential recruitable tissue: 9% (range −10-60%; Gattinoni et al, 2006) Potential recruitable tissue: 24.3% (range −2-76; Camporota et al, 2019) High variability of opening lung pressures (Caironi et al, 2015) Findings that predicted more lung re-aeration…”

Section: Ards Non-ardsmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

Background: Recruitment maneuvers (RMs) have heterogeneous effects on lung aeration and have adverse side effects. We aimed to identify morphological, anatomical, and functional imaging characteristics that might be used to predict the RMs on lung aeration in invasively ventilated patients.Methods: We performed a systemic review. Studies included invasively ventilated patients who received an RM and in whom re-aeration was examined with chest computed tomography (CT), electrical impedance tomography (EIT), and lung ultrasound (LUS) were included.Results: Twenty studies were identified. Different types of RMs were applied. The amount of re-aerated lung tissue after an RM was highly variable between patients in all studies, irrespective of the used imaging technique and the type of patients (ARDS or non-ARDS). Imaging findings suggesting a non-focal morphology (i.e., radiologic findings consistent with attenuations with diffuse or patchy loss of aeration) were associated with higher likelihood of recruitment and lower chance of overdistention than a focal morphology (i.e., radiological findings suggestive of lobar or segmental loss of aeration). This was independent of the used imaging technique but only observed in patients with ARDS. In patients without ARDS, the results were inconclusive.Conclusions: ARDS patients with imaging findings suggestive of non-focal morphology show most re-aeration of previously consolidated lung tissue after RMs. The role of imaging techniques in predicting the effect of RMs on re-aeration in patients without ARDS remains uncertain.

show abstract

Section: Recruitment Methodology and Identification Of "Responders"mentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Ards Non-ardsmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Positive expiratory pressure, set to prevent alveolar collapse, leads to right atrium preload decrease and right ventricle (RV) afterload increase [1,11]. However, due to quite sophisticated and often unpredictable heart-lung interaction [14], high PEEP values during the recruitment maneuver may, in contrast, improve RV performance [15,16].…”

Section: Introductionmentioning

confidence: 99%

Heart-Protective Mechanical Ventilation in Postoperative Cardiosurgical Patients

Мазурок

Kasherininov

Баутин

et al. 2021

Critical Care Research and Practice

View full text Add to dashboard Cite

Background. This study compared the hemodynamic effects and gas exchange under several different ventilator settings—with regard to tidal volume, respiratory rate, and end-expiratory pressure—in patients after coronary artery bypass grafting (CABG). Methods. Prospective interventional cohort study with a controlled group in a single cardiosurgical ICU involving 119 patients following on-pump CABG surgery. During the 1st postoperative hour, the intervention group patients were ventilated with Vt 10 ml × kg−1, RR 14/min, PEEP 5 cmH2O (“conventional ventilation”). During the 2nd hour, RR was reduced to 8/min (“reduced RR ventilation”). At 3 hrs, Vt was decreased to 6 ml × kg−1, RR returned to 14/min, and PEEP increased to 10 cmH2O (“low Vt-high PEEP ventilation”). Results. Patients in the “low Vt-high PEEP” ventilation period showed significantly lower alveolar ventilation and thoraco-pulmonary compliance than during “reduced RR” ventilation. Mean airway pressure and Vds/Vt peaked during low Vt-high PEEP ventilation; however, driving pressure was lower. Vt decrease and PEEP increase did not lead to oxygenation improvement and worsened CO2 elimination. Hemodynamically, the study revealed significant cardiac output decrease during low Vt-high PEEP ventilation. In 23.2% of patients, catecholamine therapy was initiated. Conclusions. In postoperative cardiosurgical patients, MV with Vt 6 ml × kg−1 and PEEP 10 cm H2O is characterized by worsened oxygenation and elimination of CO2 and a less favorable hemodynamic profile than ventilation with Vt 10 ml × kg−1 and PEEP 5 cmH2O. New and Noteworthy. (i) Patients after CABG may be especially sensitive to low tidal volume and increased PEEP as it negatively affects hemodynamic profile by means of the right heart preload decrease and afterload increase. (ii) Mechanical ventilation settings aiming to minimize mean airway pressure reduce the negative effects of positive inspiratory pressure and are favorable for hemodynamics.

show abstract

“…In those patients undergoing cardiac surgery with cardiopulmonary bypass, significant atelectasis occurs which impairs right ventricular (RV) function. However, lung recruitments using positive pressure have been shown to re-expand collapsed alveoli and improve RV function (23)(24)(25)(26). There is a theoretical risk of developing barotrauma leading to pneumomediastinum or pneumothorax during a recruitment; however this is likely less a risk in cardiac surgical patients with relatively healthy lungs (10,27,28).…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Devor¹,

Bassi²,

Kang³

et al. 2020

Southwest J Pulm Crit Care

View full text Add to dashboard Cite

Background: Recruitment maneuvers are a dynamic process of transient increases in transpulmonary pressure intended to open unstable airless alveoli. Due to concerns regarding the hemodynamic consequences of recruitment maneuvers in children with heart disease, these maneuvers have not been widely utilized in this population. The objective of this study was to demonstrate the safety and efficacy of lung recruitment maneuvers in post-operative pediatric cardiac patients. We hypothesized that multiple recruitment maneuvers are physiologically beneficial and hemodynamically tolerated in children with congenital cardiac disease. Methods: Retrospective chart review was conducted of post-operative cardiac surgical subjects who received recruitment maneuvers, as well as a matched control group who did not, at a Cardiac ICU in a quaternary care free-standing children's hospital. Repetitive lung recruitment maneuvers using incremental positive end-expiratory pressure were performed. Hemodynamic and respiratory physiologic variables were recorded. Results: Sixty-one post-operative cardiac subjects had a total of 435 lung recruitment maneuvers. Assessment of hemodynamic tolerability demonstrated no change in MAP, HR, or CVP during or after the maneuvers. There was a 28% increase in dynamic compliance following recruitment maneuvers (p <0.01, 95% CI). Specific outcomes in the 59 matched control subjects demonstrated no significant difference in length of mechanical ventilation (p = 0.26), length of hospital stay (p = 0.28), mortality (p = 0.58) or difference in occurrence of pneumothorax (p = 0.26).

show abstract

Lung recruitment improves right ventricular performance after cardiopulmonary bypass

Abstract: Protocol started on October 2014.

Cited by 23 publications

References 45 publications

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

Heart-Protective Mechanical Ventilation in Postoperative Cardiosurgical Patients

Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Contact Info

Product

Resources

About