Pulmonary function, cardiac status, and postoperative course in relation to cardiopulmonary bypass

Andersen, Nikaan B.; Ghia, Jawahar N.

doi:10.1016/s0022-5223(19)42445-8

Cited by 45 publications

(3 citation statements)

References 17 publications

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“…Earlier studies reported more severe pulmonary abnormalities, persisting for as long as four months postoperatively. 23,32,33 The fact that there has been a reduction in the severity and the shorter duration of these abnormalities is likely to be attributed to the refinements in the CPB equipment.…”

Section: Discussionmentioning

confidence: 99%

Does cold blood cardioplegia solution cause deterioration in clinical pulmonary function following coronary artery bypass graft surgery?

McFarlane

Kleinloog

2007

Perfusion

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Section: Discussionmentioning

confidence: 99%

Does cold blood cardioplegia solution cause deterioration in clinical pulmonary function following coronary artery bypass graft surgery?

McFarlane

Kleinloog

2007

Perfusion

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“…Cardiac surgery requires prolonged general anaesthesia, extensive intrathoracic surgical manipulation and institution of cardiopulmonary bypass (CPB). It has been shown that changes in lung function after cardiac surgery are more pronounced compared with those after other types of major surgery [4]. Pulmonary dysfunction after CPB has been described in terms of a reduction in lung volumes [5], altered lung and chest wall mechanics [6,7], an increase in extravascular lung water content [8,9], ventilation‐perfusion mismatch [10], a decrease in pulmonary surfactant activity [11] and changes in the fine structure of the lungs [12,13].…”

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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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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“…Numerous studies followed documenting the benefits of positive Presented in part at "Frontiers in Perioperative Myocardial Management," Montreal, Canada, October 27, to 30, 1994. pressure ventilation, which included treatment of respiratory failure, oxygenation of the arterial blood, reduction of respiratory dead space, and reduction of the work of breathing. [2][3][4] The introduction of high-dose narcotic anesthesia by Lowenstein et aL5 in 1969 further encouraged the practice of postoperative ventilation because of the long pharmacological duration of action of the available narcotics. Synthetic narcotics such as fentanyl have little or no direct myocardial depression, provide excellent circulatory stability, and long-acting analgesia for both incisional pain and endotracheal tube tolerance.…”

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confidence: 99%

Timing of Tracheal Extubation in Adult Cardiac Surgery Patients

Hickey

Cason

1995

J Cardiac Surgery

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In this article, we examine 14 studies conducted from 1974 to 1994 on "early" endotracheal extubation (0 to 12 hours postoperatively) in adult cardiac surgery patients. Aspects reviewed include: criteria for patient selection; criteria for extubation; analyses of feasibility and safety; effects of anesthetic technique; and patient morbidity. Advantages and disadvantages of early or "fast-track" extubation are discussed as are directions for future research. Selection criteria varied among studies; patients were most commonly excluded because of severe, preexisting pulmonary disease or ventricular dysfunction. Based on the studies examined, however, at least 70% to 80% of adult patients would meet selection criteria. Three universal criteria were applied in all studies: (1) patient is awake and responsive; (2) adequate gas exchange while breathing spontaneously; and (3) cardiovascular stability. To facilitate early extubation in appropriately selected patients, the choice of anesthetic technique and postoperative sedation technique appears to be important. Anesthetic techniques based on inhalational anesthetic agents, supplemented by moderate doses of narcotics, are more appropriate than high-dose narcotic anesthesia for early extubation protocols. Postoperative sedation with propofol, which has a rapid offset of action, may be particularly advantageous. Every published investigation has concluded that early extubation is safe, feasible, and desirable. Morbidity and mortality have not been shown to be affected by early extubation. Anesthetic technique and the patient's medical condition are the two major factors to consider in accomplishing early extubation.

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Pulmonary function, cardiac status, and postoperative course in relation to cardiopulmonary bypass

Cited by 45 publications

References 17 publications

Does cold blood cardioplegia solution cause deterioration in clinical pulmonary function following coronary artery bypass graft surgery?

Does cold blood cardioplegia solution cause deterioration in clinical pulmonary function following coronary artery bypass graft surgery?

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

Timing of Tracheal Extubation in Adult Cardiac Surgery Patients

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