DOI: 10.1213/01.ane.0000492455.68115.b5

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Issn Print: 0003-2999

Publication Date: 2016/09/01


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Abstract PR045: Comparative Evaluation of Lungs Protection Techniques in Adults with Pulmonary Hypertension During Open Heart Surgery

V. Pichugin; S. Domnin; I. Kurapeev; V. Bober

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Author Information: Anesthesiology and Intensive Care, Nizhny Novgorod State Medical Academy,

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Background & Objectives: Cardiac surgery with cardiopulmonary bypass (CPB) twice increases pulmonary dysfunction rate (PDR) compared with off-pump cardiac surgery (Nozawa E. et al., 2003). Pulmonary hypertension (PH) sharply increases postoperative PDR associated with CPB (Gabriel E.A., Salerno T.A., 2010). The aim of our study was to evaluate oxygenated and nonoxygenated blood pulmonary artery perfusion with reduced volumes lungs ventilation during CPB for lungs protection compared with conventional (no lung ventilation/ perfusion) technique for adults with PH.
Materials & Methods: 70 patients undergoing valves surgery with CPB, were randomized in three groups. All patients had PH (mean pulmonary artery pressure was 42,2±5,5 mm Hg). 1-st group (27 patients) – conventional (no lung ventilation/perfusion) technique was used, 2-nd group (24 patients) – oxygenated blood pulmonary artery perfusion with lung ventilation were used, 3-rd group (19 patients) - nonoxygenated blood pulmonary artery perfusion with lung ventilation were used. We evaluated alveolar-arterial oxygen difference (AAOD), oxygenation index (OI), PaCO2, F-shunt parameter and lung compliance (LC) during operation.
Results: Initial data had no significant differences between groups. 1st group patients had significantly higher AAOD (by 20.5%), lower OI (by 16.8%), increased F-shunt (by 21.9%), lower LC (by 17.5%) after CPB. We registered progression of these disturbances to the end of surgery (AAOD increased by 31.5%, OI decreased by 24.3%, F-shunt increased by 34.4%, LC decreased by 21.1%). PaCO2 increased by 10.8% at the same stage. Such parameters as AAOD, OI, F-shunt and LC had not differences compared with initial levels in 2nd and 3rd group patients, but were significantly changed compared with 1st group. At the end of operation OI and LC levels were significantly higher in 2nd and 3rd group compared with 1st group. There were not significant differences between patients 2nd and 3rd group at all stages of the study.
Conclusion: Pulmonary artery perfusion and ventilation during CPB effectively preserved lungs oxygenation function, lung complains, decreased intrapulmonary blood shunt after cardiopulmonary bypass in patients with pulmonary hypertension. There were not significant differences between oxygenated and nonoxygenated blood pulmonary perfusion.
References:
1. Nozawa E., Kobayashi E., Matsumoto M.E., Feltrim M.I., Carmona M.J., Auler J.J. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery. Arq. Bras. Cardiol. 2003; 80: 301–10.
2. Gabriel E.A., Salerno T.A. Principles of Pulmonary Protection in Heart Surgery.// Springer-Verlag London Limited, 2010. – 453p.

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