Alveolar recruitment manoeuvre is safe in children prone to pulmonary hypertensive crises following open heart surgery: a pilot study.
OBJECTIVE
To test the tolerance and safety of an alveolar recruitment manoeuvre performed in the immediate postoperative period of corrective open heart surgery in children with congenital heart disease associated with excessive pulmonary blood flow and pulmonary arterial hypertension due to left-to-right shunt.


METHODS
Ten infants aged 1-24 months with congenital heart disease associated with excessive pulmonary blood flow and pulmonary artery hypertension (mean pulmonary artery pressure ≥ 25 mmHg) were evaluated. The alveolar recruitment manoeuvre was performed in the operating theatre right after skin closure, and consisted of three successive stages of 30 s each, intercalated by a 1-min interval of baseline ventilation. Positive end-expiratory pressure was set to 10 cmH2O in the first stage and to 15 cmH2O in the two last ones, while the peak inspiratory pressure was kept at to 30 cmH2O in the first stage and at 35 cmH2O in the latter ones. Haemodynamic and respiratory variables were recorded.


RESULTS
There was a slight but significant increase in mean pulmonary artery pressure from baseline to Stage 3 (P = 0.0009), as well as between Stages 1 and 2 (P = 0.0001), and 1 and 3 (P = 0.001), with no significant difference between Stages 2 and 3 (P = 0.06). Upon completion of the third stage, there were significant increases in arterial haemoglobin saturation as measured by pulse oximetry (P = 0.0009), arterial blood partial pressure of oxygen (P = 0.04), venous blood oxygen saturation of haemoglobin (P = 0.03) and arterial oxygen partial pressure over inspired oxygen fraction ratio (P = 0.04). A significant reduction in arterial blood partial pressure of carbon dioxide (P = 0.01) and in end tidal carbon dioxide also occurred (P = 0.009). The manoeuvre was well tolerated and besides a slight and transitory elevation in mean pulmonary artery, no other adverse haemodynamic or ventilatory effect was elicited.


CONCLUSIONS
The alveolar recruitment manoeuvre seemed to be safe and well tolerated immediately after open heart surgery in infants liable to pulmonary hypertensive crises.
Divisions of Thoracic and Cardiovascular Surgery, Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil.
Erica de Freitas
Ede F
Amorim
Viviane Assuncao
VA
Guimaraes
Fabio
F
Carmona
Ana Paula de Carvalho Panzeri
AP
Carlotti
Paulo Henrique
PH
Manso
Cesar Augusto
CA
Ferreira
Jyrson Guilherme
JG
Klamt
Walter Villela de Andrade
WV
Vicente
D062186:Arterial Pressure; D002245:Carbon Dioxide / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D013997:Time Factors; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen
Alveolar recruitment manoeuvre; Congenital heart disease; Open heart surgery; Pulmonary arterial hypertension; Pulmonary hypertensive crises