RT Journal Article
SR Electronic
T1 Strategies to reverse lung function deterioration to cardiopulmonary bypass: Comparison of ventilation management and/or bronchodilator therapies
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA2239
DO 10.1183/13993003.congress-2016.PA2239
VO 48
IS suppl 60
A1 Ferenc Peták
A1 Adam L. Balogh
A1 Gergely H. Fodor
A1 Edit Vigh
A1 Roberta Sudy
A1 Barna Babik
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/PA2239.abstract
AB The lung function deterioration to cardiopulmonary bypass (CPB) can be alleviated by recruitment manoeuvres (RM), elevating the positive end-expiratory pressure (PEEP), and/or bronchodilator therapies. We aimed at comparing the efficiency of these treatment strategies. Airway resistance (Raw), respiratory compliance (C), capnogram phase III slope (SIII), and Horowitz coefficient (HQ) were measured in anaesthetized, mechanically ventilated patients undergoing cardiac surgeries. Five different therapeutic interventions were compared to the standard post-CPB lung management with 4 cmH2O PEEP: i) application of elevated PEEP (8 cmH2O), ii) administration of 1 MAC sevoflurane (SEV) during either PEEP4 or iii) PEEP8, iv) a RM followed by PEEP8, and v) concomitant use of a RM, PEEP8, and SEV. The Raw decreased significantly in all groups, with the greatest drop after the combined application of RM, PEEP and SEV (-60±21[SD]%, p<0.001). C decreased similarly in all groups (43±33%, p<0.001) with the exception of SEV alone. SIII decreased in all patients; elevated PEEP and SEV induced the greatest changes (-32±16%, p<0.001). Significant increases in HQ were only observed in the patients receiving RM (iv: 32±27%, v: 47±28%, p<0.001). We conclude that elevated PEEP combined with RM recruit alveoli, thereby decreasing ventilation heterogeneities, increasing C and improving gas exchange. SEV contributes to the homogenization of the lungs via its bronchodilation potential. The adverse respiratory effects of CPB are complex; combination of lung recruitment and bronchodilator therapies is the most efficient as a reversal.Supported by OTKA grant K115253.