SummaryAtelectasis occurs during general anaesthesia. This is partly responsible for the impairment of gas exchange that occurs peri-operatively. During cardiopulmonary bypass, this atelectasis is exacerbated by the physical collapse of the lungs. As a result, poor arterial oxygenation is often seen postoperatively. We tested the effect of an Ôalveolar recruitment strategyÕ on arterial oxygenation in a prospective randomised study of 78 patients undergoing cardiopulmonary bypass. Patients were divided equally into three groups of 26. Group Ôno PEEPÕ received a standard post bypass manual lung inflation, and no positive end-expiratory pressure was applied until arrival at intensive care unit. Group Ô5 PEEPÕ received a standard post bypass manual inflation, and then 5 cmH 2 O of positive end-expiratory pressure was applied and maintained until extubation on intensive care. The third group, Ôrecruitment groupÕ, received a pressure-controlled stepwise increase in positive end-expiratory pressure up to 15 cmH 2 O and tidal volumes of up to 18 ml.kg )1 until a peak inspiratory pressure of 40 cmH 2 O was reached. This was maintained for 10 cycles; the positive end-expiratory pressure of 5 cmH 2 O was maintained until extubation on intensive care. There was a significantly better oxygenation in the recruitment group at 30 min and 1 h post bypass when compared with the no PEEP and 5 PEEP groups. There was no significant difference in any of the groups beyond 1 h. Application of 5 cmH 2 O positive end-expiratory pressure alone had no significant effect on oxygenation. No complications due to the alveolar recruitment manoeuvre occurred. We conclude that the application of an alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass surgery.

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A 20-year old woman presented with prolonged refractory ventricular fibrillation and pulmonary oedema following hypothermia while she was under self-administered heroin in an attempt to commit suicide. She was successfully resuscitated with cardiopulmonary bypass for core rewarming and internal defibrillation.

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