[Effects of ventilation of the lungs in prone position on the pulmonary oxygenation function and hemodynamic parameters of heart surgery patients with respiratory insufficiency in the postoperative period].
Effect of ventilation in the face-down position (VFDP) on the oxygenation function of the lungs and hemodynamics is studied in 32 patients (aged 22-64 years) subjected to open-heart surgery complicated by development of acute respiratory failure (RF). In 23 patients with grave respiratory distress syndrome, VFDP was performed with forced ventilation of the lungs (FVL) and in 9 with less grave RF, with noninvasive mask ventilation of the lung (NIMVL). Body position of patients on FVL was changed every 4-12 h, of nonintubated patients, 45-60 min. The oxygenation function of the lungs improved in the intubated patients as early as during the first hour of FVL in the face-down position: PaO2/FiO2 notably increased and a tendency to decrease of A-aDO2 and Qs/Qt was observed. The positive effect was maximal after at least 4-hour FVP in the face-down position: PaO2/FiO2 increased by 76.6%, intrapulmonary shunting fraction decreased by 43%, and the O2 alveolar-arterial difference decreased by 27% in comparison with the initial values. After body position of patients was changed, the above improvements did not disappear, despite a slight decrease of the effect attained. VFDP with NIMVL led to similar results: O2 alveolar-arterial gradient decreased, PaO2/FiO2 decreased by 24.2%, the mean values of this ratio approaching the norm. Positive effect somewhat decreased after catecholamines were discontinued, but the oxygenation function of the lungs remained better than initially.
Eremenko
A A
AA
Levikov
D I
DI
Egorov
V M
VM
Ziulaeva
T P
TP
Chaus
N I
NI
D000328:Adult; D006348:Cardiac Surgical Procedures; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy; D011183:Postoperative Complications / Q000628:therapy*; D016684:Prone Position; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
D010100:Oxygen