title: Open lung ventilation improves functional residual capacity after extubation in cardiac surgery.
abstract: OBJECTIVE
  After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation.
  
  
  METHODS
  A prospective, single-center, randomized, controlled clinical study.
  
  
  METHODS
  Cardiothoracic operating room and intensive care unit of a university hospital.
  
  
  METHODS
  Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass.
  
  
  METHODS
  Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until Pao2/Fio2 was >375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group.
  
  
  RESULTS
  FRC was measured preoperatively and 1, 3, and 5 days after extubation. Peripheral hemoglobin saturation (Spo2) was measured daily till the third day after extubation while the patient was breathing room air. Hypoxemia was defined by an Spo2 value < or =90%. Averaged over the 5 postoperative days, FRC was significantly higher in the early open lung group and tended to be higher in the late open lung group, in comparison with the CV group (mean +/- sem: CV, 1.8 +/- 0.1; late open lung,1.9 +/- 0.1; and early open lung, 2.2 +/- 0.1l). In the CV group, 37% of the patients were hypoxic on the third day after extubation, compared with none of the patients in both OLC groups.
  
  
  CONCLUSIONS
  After cardiac surgery, earlier application of OLC resulted in a significantly higher FRC and fewer episodes of hypoxemia than with CV after extubation.
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Dinis
authors.initials: D
authors.lastname: Reis Miranda
authors.forename: Ard
authors.initials: A
authors.lastname: Struijs
authors.forename: Peter
authors.initials: P
authors.lastname: Koetsier
authors.forename: Robert
authors.initials: R
authors.lastname: van Thiel
authors.forename: Ronald
authors.initials: R
authors.lastname: Schepp
authors.forename: Wim
authors.initials: W
authors.lastname: Hop
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Burkhard
authors.initials: B
authors.lastname: Lachmann
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Diederik
authors.initials: D
authors.lastname: Gommers
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D005541:Forced Expiratory Volume; D005652:Functional Residual Capacity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011182:Postoperative Care; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000517:prevention & control; D014797:Vital Capacity