Pulmonary abnormalities after coronary arterial bypass grafting operation: cardiopulmonary bypass versus mechanical stabilization

Kochamba, Gary S.; Yun, Kwok L.; Pfeffer, Thomas; Sintek, Colleen F.; Khonsari, Siavosh

doi:10.1016/s0003-4975(00)01142-5

Cited by 70 publications

(63 citation statements)

References 15 publications

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“…Four hours after extubation, the shunt was shown to be around 25.6 ± 8.1%. This result was confirmed by a recent study which showed the shunt as 30.3 ± 14.1% [16]. Moreover, Bender et al showed that the pulmonary shunt can still be high at 24 hours after extubation (29 ± 12.3%) [17].…”

Section: Introductionsupporting

confidence: 59%

“…Increased Qs/Qt is a well-documented and undesirable phenomenon after CPB in cardiac surgery patients [5,11,13,14,16,26,30]. The effects of pulmonary atelectasis during CPB on post-CPB shunting and oxygenation is well demonstrated in animals and humans and is seen especially at the end of the surgery [11,15.26].…”

Section: Discussionmentioning

confidence: 99%

“…Intrapulmonary shunt after cardiac surgery was reported to vary from around 16% at the end of surgery, increased fastly after 4 hours and reached 29% at 24 hours [15][16][17]. Our sample size was calculated to reduce intrapulmonary shunt gradient from 29% to 19% in RMM compared to SC.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in our study, a third group without the SRM performed before the end of surgery could have been included and would have helped to calculate the particular effect of this manoeuvre in our SC group. In both groups, no need for re-exploration for bleeding was required and no clinical significant adverse hemodynamic effects in our study [1,3,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Riachy¹,

Ibrahim²,

Sleilaty³

et al. 2017

Lung Breath J

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Cardiopulmonary bypass surgery has been implicated in causing atelectasis; a major cause of intrapulmonary shunting and hypoxemia postoperatively. This study investigated if repetitive lung recruitment manoeuvres (RRM), before and after extubation, could reduce intrapulmonary shunting for a longer period post-extubation than only one standardized recruitment manoeuvre (SRM), Forty cardiac valve replacement patients were randomised after SRM into two groups: RRM group (n=20): Total vital capacity manoeuvre at surgery end and repeated every 4 hours until extubation; SC group (n=20): Standard care with SRM. Intrapulmonary shunts (Qs/Qt) were measured after anaesthesia induction, at surgery termination and every 4 hours until 24 hours post-extubation. Time to extubation was recorded. Lung function was measured every 12 hours until discharge.A 24 hour post-extubation ANOVA showed no Qs/Qt significant differences between RRM and SC group (4.5 ± 3.3% and 5.3 ± 2.4%). At surgery end, Qs/Qt increased in RRM group (7.3 ± 3.2% to 13.5 ± 3.7%; p<10-3) but was significantly less (p<0.02) compared to SC group (7.3 ± 3.7% to 16.1 ± 6%; p<10-3). Time to extubation was 8.8 ± 4.2 h in RRM group versus 10.4 ± 4.3 h SC group (p<0.2, ns). No significant difference in vital capacity was seen in the RRM group (3.17 ± 1.2 to 1.9 ± 1 l) compared to SC group (3.4 ± 0.8 to 2.1 ± 0.9 l).In valve replacement surgery, RRM is only beneficial in the short-term period and does not assure a better intrapulmonary shunt benefit than one SRM applied at the end of surgery.

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Section: Introductionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Riachy¹,

Ibrahim²,

Sleilaty³

et al. 2017

Lung Breath J

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“…Reduced static and dynamic compliance is one of the characteristics of pulmonary function in patients after exposure to CPB 23,24. Postulated causes include atelectasis, pulmonary oedema, inflammation, increased capillary permeability, and pleural effusions 25.…”

Section: Discussionmentioning

confidence: 99%

Isoflurane pre-treatment before cardiopulmonary bypass alleviates neutrophil accumulation in dog lungs

Gao²,

Liu³

et al. 2011

CardioVascular Journal of Africa

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ObjectiveThis study investigated the effect of isoflurane pre-treatment on cardiopulmonary bypass (CPB)-related lung injury.MethodsTwelve dogs were randomly divided into two groups of six each. In one group, 1.0 minimum alveolar concentration (MAC) of isoflurane was administered for 30 min before CPB, while the control group received no anaesthetic. Both groups then underwent 100 min of mild hypothermic CPB with 60-min aortic cross clamping. Haemodynamic parameters, respiratory mechanics and alveolar arterial oxygen difference (AaDO2) were measured during the experiment. One hundred and fifty minutes after CPB, lung tissue samples from the non-dependent and dependent portions of the left and right lungs were harvested for polymorphonulear leukocyte (PMNs) counts.ResultsFollowing CPB, within the control group, pulmonary vascular resistance (PVR) was significantly increased at 60, 120 and 180 min after declamping, AaDO2 deteriorated at 180 min post-declamping, and dynamic lung compliance (DLC) was reduced dramatically after declamping. Isoflurane pre-treatment before CPB significantly reduced PVR compared to the controls. AaDO2 was impaired at 180 min after declamping and DLC was decreased after declamping within the isoflurane group. No differences in AaDO2 and DLC were found between the isoflurane and control groups. At 180 min after declamping, the PMN count in both the non-dependent and dependent regions of the isoflurane pre-treated lungs was significantly lower than that of the controls.ConclusionsOur results suggest that 30-min pre-treatment with 1.0 MAC isoflurane before CPB caused a reduction in PMN accumulation in the dog lungs, inhibition of increases in PVR, and it did not affect AaDO2 in the early post-CPB stage.

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Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

Møller

Penninga

Wetterslev

et al. 2012

Cochrane Database of Systematic Reviews

143

118

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Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.

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Pulmonary abnormalities after coronary arterial bypass grafting operation: cardiopulmonary bypass versus mechanical stabilization

Cited by 70 publications

References 15 publications

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Isoflurane pre-treatment before cardiopulmonary bypass alleviates neutrophil accumulation in dog lungs

Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

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