Noncardiogenic pulmonary oedema following cardiopulmonary bypass: report of two cases and review of the literature

Pezzella, A. Thomas; Ascioti, Anthony J.; Ricardi, Patrick

doi:10.1177/026765918800300104

Cited by 4 publications

(2 citation statements)

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“…The resistance of the respiratory system (R rs ) is calculated as (P peak –P plat ) flow −1 . The resistance of the respiratory system includes resistance of the airways and the endotracheal tube as well as tissue resistance [17]. The dynamic compliance of the respiratory system (C rs ) is derived from V t (P Plat –P exp ) −1 .…”

Section: Introductionmentioning

confidence: 99%

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Monitoring of respiratory function before and after cardiopulmonary bypass using side-stream spirometry

Bund

Seitz

Uthoff

et al. 1998

EJA

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Pulmonary impairment is more frequent after cardiac surgery than after other major surgical procedures. The present study investigates whether, by using standard respiratory monitoring, i.e. side-stream spirometry and blood gas analysis, it is possible to detect changes in pulmonary function secondary to cardiopulmonary bypass. We investigated 18 patients undergoing elective coronary bypass surgery or aortic valve replacement. Cardiopulmonary bypass resulted in a nonsignificant increase in alveolar-arterial oxygen difference from 33.0 +/- 10.6 kPa to 36.1 +/- 12.5 kPa and arterial to end-tidal CO2 tension difference from 0.67 +/- 0.39 kPa to 0.79 +/- 0.54 kPa. Respiratory system resistance was unaltered. In contrast, dynamic compliance decreased significantly after cardiopulmonary bypass from 78.6 +/- 22.9 to 65.4 +/- 22.4 mL cmH2O-1 with open chest and from 61.0 +/- 10.2 to 51.1 +/- 17.2 mL cmH2O-1 with closed chest, compared with corresponding values before cardiopulmonary bypass. In conclusion, pulmonary gas exchange was not compromised after cardiopulmonary bypass, but a diminished respiratory compliance was a consistent finding, even in uncomplicated cardiac surgery using routine respiratory monitoring.

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Section: Introductionmentioning

confidence: 99%

“…Respiratory abnormalities following cardiac surgery with the use of extracorporeal circulation are well‐documented [5,15–17]. Pulmonary dysfunction after cardiac surgery may be attributable to surgical manipulations including sternotomy [6], harvesting of the internal mammary artery [18,19] and pleurotomy [20].…”

Section: Introductionmentioning

confidence: 99%

Monitoring of respiratory function before and after cardiopulmonary bypass using side-stream spirometry

Bund

Seitz

Uthoff

et al. 1998

EJA

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Lung management during cardiopulmonary bypass: Influence on extravascular lung water

Boldt

King

Scheid

et al. 1990

Journal of Cardiothoracic Anesthesia

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Retracted: Does the technique of cardiopulmonary bypass affect lung water content?

Boldt

Zickmann²,

Dapper³

et al. 1991

European Journal of Cardio-Thoracic Surgery

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Several efforts have been made to improve the technique of cardiopulmonary bypass (CPB), including the use of pulsatile flow and the modification of cannulation technique. The present study focused upon extravascular lung water (EVLW) in 60 aortocoronary bypass patients subjected to four different perfusion techniques during CPB: group 1 (n = 15): non-pulsatile flow and standard cannulation; group 2 (n = 15); pulsatile flow and standard cannulation; group 3 (n = 15): nonpulsatile flow and monoatrial cannulation (i.e., always "partial" bypass during CPB); group 4 (n = 15): pulsatile flow and monoatrial cannulation. EVLW content was measured using the double-indicator dilution technique with indocyanine green; in addition, various hemodynamic and laboratory variables were measured. Lung water content rose above normal values (mean: 5.79 +/- 0.33 ml/kg) only in the groups submitted to the standard cannulation technique, irrespective of whether the perfusion flow was pulsatile or not (group 1: + 27.4%; group 2: + 25.5%). Pulmonary gas exchange, too, was compromised only in these patients (PaO2 in group 1 -19% and in group 2 -17%; Qs/Qt in group 1 + 36 rel. % and in group 2 + 29 rel. %), whereas all patients with monoatrial cannulation and partial bypass throughout the CPB period showed no rise in EVLW content or Qs/Qt and no drop in PaO2. From the results of this study we conclude that pulsatile perfusion during open heart surgical procedure has no advantages in regard to lung water content. Monoatrial cannulation with partial bypass at all times during CPB, however, seems to be beneficial, probably owing to the maintenance of pulmonary circulation during the bypass period.

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Noncardiogenic pulmonary oedema following cardiopulmonary bypass: report of two cases and review of the literature

Abstract: Two cases of noncardiogenic pulmonary oedema following cardiopulmonary bypass are presented. The clinical manifestations, postulated pathogenesis and management are discussed. A recent review of the literature fails to yield a unified explanation of this rare but often disastrous entity.

Cited by 4 publications

References 20 publications

Monitoring of respiratory function before and after cardiopulmonary bypass using side-stream spirometry

Monitoring of respiratory function before and after cardiopulmonary bypass using side-stream spirometry

Lung management during cardiopulmonary bypass: Influence on extravascular lung water

Retracted: Does the technique of cardiopulmonary bypass affect lung water content?

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