title: Alveolar recruitment strategy during cardiopulmonary bypass does not improve postoperative gas exchange and lung function.
abstract: Pulmonary dysfunction with impairment of lung function and oxygenation is one of the most serious problems in the early postoperative period after cardiac surgery. In this study we investigated the effect of alveolar recruitment strategy during cardiopulmonary bypass on postoperative gas exchange and lung function. This prospective randomized study included 32 patients undergoing elective myocardial revascularization with cardiopulmonary bypass. In 16 patients 5 cm H(2)O of positive end-expiratory pressure was applied after intubation and maintained until extubation (Group I). In the other 16 patients (group II) a positive end expiratory pressure (PEEP) of 5 cm H(2)O was maintained as well but was increased to 14 cm H(2)O every 20 min for 2 min during cross clamp. Measurements were taken preoperatively, before skin incision, before and after (3, 24, 48 h) cardiopulmonary bypass and before discharge (6th postoperative day). Postoperative gas exchange, extravascular lung water and lung function showed no significant difference between the groups. Postoperative pulmonary function variables were lower in both groups compared to baseline values. In patients with normal preoperative pulmonary function, application of an alveolar recruitment strategy during cardiopulmonary bypass does not improve postoperative gas exchange and lung function after cardiac surgery.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt/Main, Germany. M.Scherer@em.uni-frankfurt.de
authors.forename: Mirela
authors.initials: M
authors.lastname: Scherer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dettmer
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.forename: Galina
authors.initials: G
authors.lastname: Geyer
authors.forename: Caroline
authors.initials: C
authors.lastname: Regulla
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange