[Alveolar opening maneuver (mobilization) in intraoperative pulmonary oxygenizing dysfunction in cardiosurgical patients].
The purpose of the study was to investigate arterial oxygenation and hemodynamics during and after alveolar mobilization in the early post-cardiopulmonary bypass (CPB) period of cardiac surgery. The study involved 21 patients aged 30 to 73 years, who had a PaO2/FiO2 below 300 mm Hg in the early post-CPB period. PaO2/FiO2 was less than 200 mm Hg in 4 patients. Alveolar mobilization was performed by means of the "Open lung tool" function of a Servo-i respirator ("Maquet'). PaO2/FiO2 significantly increased (P < 0.5) from 244+/-11 to 472+/-20 mm Hg and thoracopulmonary compliance (Cdyn) increased from 53.3+/-3 to 67.5+/-2.9 ml/cm H20 (p < 0.5). Intrapulmonary shunt (Qs/Qt) significantly decreased from 14+/-1 to 10+/-1.5% (p < 0.5). The mean values of PaO2/FiO2 Cdyn and Qs/Qt were stable at the end of procedures. PaO/FiO, was greater than 350 mm Hg in 62% of the patients. Cardiac index considerably decreased from 2.7+/-0.1 to 225+/-0.1 l/min/m(2) at the peak of alveolar mobilization (p < 0.05); right atrial pressure and mean pulmonary artery pressure were moderately, but significantly higher at that moment. Hemodynamic parameters returned to the baseline levels after alveolar mobilization. There were no significant hemodynamic complications. It is concluded that alveolar mobilization is an effective technique in improving arterial oxygenation and lung biomechanics in cardiosurgical patients under anesthesia.
Kozlov
I A
IA
Romanov
A A
AA
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011650:Pulmonary Alveoli; D011652:Pulmonary Circulation; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*
D010100:Oxygen