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

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 H 2 O 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 (T 2 ) and after closure of sternum (T 3 ), (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 H 2 O CPAP does not improve lung function after cardiac surgery. Objectif

Blood Gases Response to Different Breathing Modalities in Phase I of Cardiac Rehabilitation Program after Coronary Artery Bypass Graft

“…No differences between groups with respect to hemodynamic variables were observed at any time. So application of 10 cm H 2 O CPAP does not improve lung function after cardiac surgery (25) or postoperative pulmonary gas exchange after CABG (26).…”

Prediction and prevention of pulmonary-pleural complications after heart valve surgery

“…При анализе результатов хирургического лечения определяют значимое увеличение летальности и частоты энцефалопатий в группе с ДН (р<0,001). Это частично со-ответствует данным авторов, которые указывают на зави-симости между развитием ДН и увеличением рисков по-чечной и неврологической дисфункции, частоты инфек-ционных осложнений и летальности [1,2,16]. По нашим данным, длительность нахождения пациентов на искус-ственной вентиляции легких и в отделении реанимации явно выше при развитии ДН (см.…”

Update on one-lung ventilation: the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation – clinical application

“…CPAP was applied during CPB and was demonstrated to improve intraoperative post-CPB shunt fraction and alveolararterial oxygen partial pressure compared with control, but these benefits did not extend into the postoperative period [65]. It is reasonable to remember that OLV is used for (mini)thoracotomy approaches to some types of cardiac surgery -primarily valvular surgery.…”