Pulmonary collapse alone provides effective de-airing in cardiac surgery: a prospective randomized study
Autor: | Faleh Al-Rashidi, Doris Cunha-Goncalves, Peter Höglund, Bansi Koul, Leif Pierre, Maya Landenhed |
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Rok vydání: | 2015 |
Předmět: |
Male
Pulmonary Atelectasis medicine.medical_specialty 030204 cardiovascular system & hematology Ventilation/perfusion ratio law.invention 03 medical and health sciences 0302 clinical medicine Aortic valve replacement law Internal medicine Ventilation-Perfusion Ratio Cardiopulmonary bypass Humans Medicine Radiology Nuclear Medicine and imaging Prospective Studies Cardiac Surgical Procedures Lung Aged Aged 80 and over Advanced and Specialized Nursing business.industry Mediastinum General Medicine Middle Aged medicine.disease Respiration Artificial Cardiac surgery medicine.anatomical_structure 030228 respiratory system Anesthesia Breathing Cardiology Female Cardiology and Cardiovascular Medicine business Safety Research Perfusion |
Zdroj: | Perfusion. 31:320-326 |
ISSN: | 1477-111X 0267-6591 |
DOI: | 10.1177/0267659115604712 |
Popis: | Objectives: We previously described and showed that the method for cardiac de-airing involving: (1) bilateral, induced pulmonary collapse by opening both pleurae and disconnecting the ventilator before cardioplegic arrest and (2) gradual pulmonary perfusion and ventilation after cardioplegic arrest is superior to conventional de-airing methods, including carbon dioxide insufflation of the open mediastinum. This study investigated whether one or both components of this method are responsible for the effective de-airing of the heart. Methods: Twenty patients scheduled for open, left heart surgery were randomized to two de-airing techniques: (1) open pleurae, collapsed lungs and conventional pulmonary perfusion and ventilation; and (2) intact pleurae, expanded lungs and gradual pulmonary perfusion and ventilation. Results: The number of cerebral microemboli measured by transcranial Doppler sonography was lower in patients with open pleurae 9 (6-36) vs 65 (36-210), p=0.004. Residual intra-cardiac air grade I or higher as monitored by transesophageal echocardiography 4-6 minutes after weaning from cardiopulmonary bypass was seen in few patients with open pleurae 0 (0%) vs 7 (70%), p=0.002. Conclusions: Bilateral, induced pulmonary collapse alone is the key factor for quick and effective de-airing of the heart. Gradual pulmonary perfusion and ventilation, on the other hand, appears to be less important. |
Databáze: | OpenAIRE |
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