Canadian Journal of Anesthesia

, Volume 53, Issue 9, pp 919–925 | Cite as

Continuous positive airway pressure does not improve lung function after cardiac surgery

  • Ece Altmay
  • Pelin Karaca
  • Nurgül Yurtseven
  • Vedat Özkul
  • Tamer Aksoy
  • Azmi Özler
  • Sevim Canik
Cardiothoracic anesthesia, respiration and airway

Abstract

Purpose

Despite the well-documented impairment of pulmonary function after cardiopulmonary bypass, effective precautions and ideal management strategies for this problem are still under debate. This study aimed to evaluate the effects of continuous positive airway pressure (CPAP) applied during cardiopulmonary bypass on respiratory and hemodynamic variables.

Methods

In this randomized, prospective, controlled trial, 120 male patients, aged 45 to 70 yr undergoing first-time elective bypass surgery, were randomly assigned to receive either 10 cm H2O of CPAP (Group I; n = 60) during cardiopulmonary bypass, or serve as control (Group II; n = 60), where the patient’s lungs were vented to atmosphere during the bypass period.

Results

Alveolar-arterial oxygen partial pressure difference and shunt fraction were significantly higher in the control group compared with the CPAP group after cardiopulmonary bypass (T2) and after closure of sternum (T3), (P < 0.05). No differences between groups with respect to hemodynamic variables were observed at any time. Postoperative pulmonary function variables were lower in both groups compared to baseline values.

Conclusions

Continuous positive airway pressure administered during cardiopulmonary bypass decreased shunt fraction and alveolar-arterial oxygen partial pressure difference during surgery, but had no sustained effect on either variable postoperatively. We conclude that, in patients with normal preoperative pulmonary function, application of 10 cm H2O CPAP does not improve lung function after cardiac surgery.

Keywords

Mean Arterial Pressure Cardiopulmonary Bypass Force Vital Capacity Pulmonary Capillary Wedge Pressure Improve Lung Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La ventilation en pression positive continue n’améliore pas la fonction pulmonaire après la cardiochirurgie

Résumé

Objectif

Malgré les connaissances acquises sur l’atteinte de la fonction pulmonaire après la circulation extracorporelle, les précautions efficaces et le traitement idéal touchant ce problème font toujours l’objet de débats. Nous voulions évaluer les effets d’une ventilation en pression positive continue (CPAP pour «continuous positive airway pressure») pendant la circulation extracorporelle sur les variables respiratoires et hémodynamiques.

Méthode

Dans notre étude randomisée, prospective et contrôlée, 120 hommes de 45 à 70 ans devant subir un premier pontage électif, ont reçu soit 10 cm H2O de CPAP (Groupe I; n = 60) pendant la circulation extracorporelle, soit ont servi de témoins (Groupe II; n = 60) et les poumons ont été ventilés à la pression atmosphérique pendant le pontage.

Résultats

La différence alvéolaire-artérielle de pression partielle en oxygène et la fraction de shunt ont été significativement plus élevées chez les témoins que chez les patients sous CPAP après la circulation extracorporelle (T2) et après la fermeture du sternum (T3), (P < 0,05). Les variables hémodynamiques ont toujours été similaires dans les deux groupes. Dans les deux groupes aussi, les variables de la fonction pulmonaire postopératoire étaient plus basses que les valeurs de départ.

Conclusion

La ventilation à pression positive continue pendant la circulation extracorporelle a réduit la fraction de shunt et la différence alvéolaire-artérielle de pression partielle en oxygène pendant l’opération, mais n’a pas eu d’effet postopératoire prolongé sur chacune des variables. Donc, chez les patients dont la fonction pulmonaire préopératoire est normale, une CPAP de 10 cm H2O n’améliore pas la fonction pulmonaire après la cardiochirurgie.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Ece Altmay
    • 1
  • Pelin Karaca
    • 1
  • Nurgül Yurtseven
    • 1
  • Vedat Özkul
    • 1
  • Tamer Aksoy
    • 1
  • Azmi Özler
    • 2
  • Sevim Canik
    • 1
  1. 1.From the Department of Anesthesiology and ReanimationDr. Siyami Ersek Thoracic and Cardiovascular Surgery CenterÏstanbul
  2. 2.and the Department of Thoracic and Cardiovascular SurgeryDr. Siyami Ersek Thoracic and Cardiovascular Surgery CenterÏstanbul

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