title: Lung recruitment improves right ventricular performance after cardiopulmonary bypass: A randomised controlled trial.
abstract: BACKGROUND
  Atelectasis after cardiopulmonary bypass (CPB) can affect right ventricular (RV) performance by increasing its outflow impedance.
  
  
  OBJECTIVE
  The aim of this study was to determine whether a lung recruitment manoeuvre improves RV function by re-aerating the lung after CPB.
  
  
  METHODS
  Randomised controlled study.
  
  
  METHODS
  Single-institution study, community hospital, Córdoba, Argentina.
  
  
  METHODS
  Forty anaesthetised patients with New York Heart Association class I or II, preoperative left ventricular ejection fraction at least 50% and Euroscore 6 or less scheduled for cardiac surgery with CPB.
  
  
  METHODS
  Patients were assigned to receive either standard ventilation with 6 cmH2O of positive end-expiratory pressure (PEEP; group C, n = 20) or standard ventilation with a recruitment manoeuvre and 10 cmH2O of PEEP after surgery (group RM, n = 20). RV function, left ventricular cardiac index (CI) and lung aeration were assessed by transoesophageal echocardiography (TOE) before, at the end of surgery and 30 min after surgery.
  
  
  METHODS
  RV function parameters and atelectasis assessed by TOE.
  
  
  RESULTS
  Haemodynamic data and atelectasis were similar between groups before surgery. At the end of surgery, CI had decreased from 2.9 ± 1.1 to 2.6 ± 0.9 l min m in group C (P = 0.24) and from 2.8 ± 1.0 to 2.6 ± 0.8 l min m in group RM (P = 0.32). TOE-derived RV function parameters confirmed a mild decrease in RV performance in 95% of patients, without significant differences between groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present in 18 patients in group C and 19 patients in group RM (P = 0.88). After surgery, CI decreased further from 2.6 to 2.4 l min m in group C (P = 0.17) but increased from 2.6 to 3.7 l min m in group RM (P < 0.001). TOE-derived RV function parameters improved only in group RM (Hotelling t-test P < 0.001). Atelectasis was present in 100% of patients in group C but only in 10% of those in group RM (P < 0.001).
  
  
  CONCLUSIONS
  Atelectasis after CPB impairs RV function but this can be resolved by lung recruitment using 10 cmH2O of PEEP.
  
  
  BACKGROUND
  Protocol started on October 2014.
authors.affiliation: From the Department of Anesthesia (SL), Department of Intensive Care (IC), Department of Cardiovascular Surgery, Hospital Privado Universitario de Córdoba, Córdoba (AP), Department of Anesthesia, Hospital Privado de Comunidad (CA, GT), Department of Mathematics Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Mar del Plata Argentina (LR, MN), Department of Surgical Sciences, Section of Anesthesia and Critical Care, Uppsala University Hospital; Hedenstierna Laboratory, Uppsala, Sweden (FS-S) and CIBERES. Madrid, Spain (FS-S).
authors.forename: Silvina
authors.initials: S
authors.lastname: Longo
authors.forename: Juan
authors.initials: J
authors.lastname: Siri
authors.forename: Cecilia
authors.initials: C
authors.lastname: Acosta
authors.forename: Alberto
authors.initials: A
authors.lastname: Palencia
authors.forename: Arturo
authors.initials: A
authors.lastname: Echegaray
authors.forename: Iván
authors.initials: I
authors.lastname: Chiotti
authors.forename: Andrés
authors.initials: A
authors.lastname: Parisi
authors.forename: Lila
authors.initials: L
authors.lastname: Ricci
authors.forename: Marcela
authors.initials: M
authors.lastname: Natal
authors.forename: Fernando
authors.initials: F
authors.lastname: Suarez-Sipmann
authors.forename: Gerardo
authors.initials: G
authors.lastname: Tusman
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016278:Ventricular Function, Right / Q000502:physiology*