Volemic and Hemodynamic Status of Patients With Comorbidity of Coronary Heart Disease and Chronic Obstructive Pulmonary Disease Before and After Myocardial Revascularization

Geltzer, B; Sergeyev, Elena; Rublev, V. Yu.; Сергеева, Е. В.; Velichkin, V. Yu.

doi:10.36604/1998-5029-2019-74-8-15

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…При этом ОПЛ -среди наиболее опасных осложнений КШ, выполненных в условиях ИК. К субклиническим проявлениям ОПЛ относят дисбаланс волемического статуса легких, который развивается вследствие повышения проницаемости легочных сосудов [9,10]. Использование показателей волемического статуса легких и транспорта кислорода позволило оценить протективный потенциал небулизированного будесонида для защиты респираторной системы от комплекса повреждающих факторов СВР и ишемии / реперфузии.…”

Section: Discussionunclassified

“…Медиана продолжительности ИВЛ в послеоперационном периоде у больных 1-й и 2-й группы составила 3,7 и 4,5 ч соответственно (p = 0,048). При этом госпитализация больных 1-й группы длилась 13,5 (9,(8)(9)(10)(11)(12)(13)(14)6) дня, а у пациентов 2-й группы -14,3 (10,2-15,2) дня (p = 0,056).…”

Section: результатыunclassified

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Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Sergeev

Гельцер

Kotelnikov

et al. 2022

Pulʹmonologiâ (Mosk.)

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Lung protection during surgeries with artificial circulation (AC) is a vital task in clinical medicine.The aim. Evaluation of the effectiveness of intraoperative administration of nebulized budesonide for correcting the volume status of the lungs and oxygen transport in patients with concomitant coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).Methods. The pilot clinical study included 40 patients with concomitant CHD and COPD who were admitted for scheduled CABG with AC. The first groups consisted of 20 patients who underwent low-volume artificial lung ventilation (AVL) with inhalation of nebulized budesonide in the process of AC; the second group consisted of 20 patients who underwent AC according to a routine technique with AVL off. Lung volemic status parameters were recorded by transpulmonary thermodilution using the Pulsion PiCCO in three stages: before the onset of AC, after its completion and one day after AC.Results. It was established that after withdrawal from AC, indices of extravascular water in the lungs (IEWL) decreased by 23% in the first group and increased by 24% in the second group. After the completion of AC and a day after it, IEWL significantly decreased in patients receiving budesonide and increased with a maximum rise at the second stage of the study in the second group. The index of oxygen delivery and utilization over time was within the reference range in all patients. The index of oxygen consumption did not reach the physiologically normal lower limit. The maximum level of pulmonary bypass blood fraction (16 and 12%, respectively) and a significant decrease in oxygenation index (240 – 290 c. u.) were recorded in this cohort of patients at the 2nd and 3rd stages of the study. The duration of postoperative ventilation was significantly longer in the second group, while the duration of in-hospital treatment did not differ significantly before the groups.Conclusion. The protective effects of the combination of aerosol therapy with budesonide and low-volume AVL were manifested by a decrease in the permeability of the pulmonary capillaries, the volume of IEWL, an improvement in the oxygenating function of the lungs, a decrease in the number of respiratory complications and the postoperative duration of AVL.

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Section: Discussionunclassified

Section: результатыunclassified

Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Sergeev

Гельцер

Kotelnikov

et al. 2022

Pulʹmonologiâ (Mosk.)

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“…В настоящем исследовании у всех пациентов с ИБС до оперативного лечения и после отхода от ИК фракция веноартериального шунта была выше нормативных значений и достигала максимального уровня при респираторной коморбидности, что ассоциировалось с нарушением вентиляционно-перфузионных отношений в результате субклинического отека легких и подтверждалось показателем ИВСВЛ. Рост венозной примеси у больных ХОБЛ связан с резко выраженной эндотелиальной дисфункцией легочных сосудов, приводящей к нарушению регуляции их тонуса и препятствующей эффективной реализации рефлекса Эйлера-Лильестранда, что приводит к сохранению кровотока в невентилируемых альвеолах [4]. После отхода от ИК увеличение венозной примеси может быть обусловлено также периферическим шунтированием в микроциркуляторном русле большого круга кровообращения с ограничением экстракции кислорода, что в нашем исследовании подтверждалось низким уровнем O 2 ER.…”

Section: Relationships Andunclassified

“…Патофизиологические последствия реперфузионных процессов связаны с накоплением внесосудистой жидкости в легких за счет увеличения проницаемости их капилляров и возрастающей вероятностью острых повреждений легких. Наличие определённых видов коморбидной патологии у больных ИБС существенно ухудшает исходный статус гемоциркуляции и может быть дополнительным фактором риска реперфузионных нарушений [4]. Именно поэтому у больных данной категории выполнение КШ с ИК должно обеспечиваться более тщательным волюметрическим и гемодинамическим мониторингом.…”

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Lungs volume status and oxygen transport in patients with coronary artery disease with various types of comorbidity before and after coronary artery bypass grafting

et al. 2021

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Aim. Assessment of lung volume status and oxygen transport system in patients with coronary artery disease (CAD) with different clinical types of comorbidity before and after coronary artery bypass grafting (CABG).Material and methods. The observational controlled study included 66 patients with CAD with a median age of 67 years (95% confidence interval [59; 74]), admitted to the Far Eastern Federal University Hospital for elective CABG. Depending on the prevalence of clinical manifestations of comorbidities, CAD patients were ranked into 3 groups of comorbidity: cardiovascular, respiratory and metabolic. The first of them was represented by a combination of CAD and peripheral artery disease, the second — CAD and chronic obstructive pulmonary disease (COPD),the third — CAD and metabolic syndrome. All patients underwent isolated CABG under cardiopulmonary bypass (CPB). Volume and hemodynamic monitoring was carried out by transpulmonary thermodilution using the Pulsion PiCCO Plus (Germany) technology and the following indices: cardiac function index (CFI), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI). Pulmonary blood volume and oxygen transport indices were determined: oxygen delivery (DO2I) and consumption (VO2I) indices, oxygen-utilization coefficient, and pulmonary shunt fraction (Qs/Qt). The study was carried out in three stages: before the onset of CABG, after its completion and one day after CABG.Results. The analysis of volume and hemodynamic monitoring data demonstrated the heterogeneity of their changes during CABG and one day after with different comorbidity profile. A more noticeable inhibition of the circulatory component of oxygen transport was revealed in patients with COPD, which was illustrated by the lowest CFI (3,2-3,4 ml/min) in relation to other groups of patients. The imbalance of cardio-respiratory interactions in this cohort after withdrawal from cardiopulmonary bypass was manifested by lower DO2I and VO2I and a maximum increase in Qs/Qt, exceeding 1,6 times the comparison groups. The respiratory and metabolic comorbidity of CAD was characterized by a significantly larger volume of extravascular lung water due to the higher permeability of the pulmonary vessels, which was documented by EVLW values, which exceeded the upper reference limit by 1,8-2 times and an increase in PVPI. In patients with cardiovascular comorbidity, lung volume violation was less noticeable.Conclusion. A comprehensive analysis of lung volume status and oxygen transport makes it possible to more accurately assess the functional status of patients with CAD, to increase the effectiveness of risk stratification and to prevent possible complications during CABG and in the early postoperative period.

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Comparative analysis of intraoperative lung protection technologies in patients having cardiorespiratory comorbidity during coronary bypass surgery with artificial circulation

Sergeev

Гельцер

Brodskaya

et al. 2022

Tihookeanskij medicinskij žurnal

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Objective: Comparative analysis of the effect of budesonide and low-volume artificial lung ventilation (ALV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients having cardio-respiratory comorbidity during сoronary artery bypass graft (CABG) with artificial blood circulation (ABC).Methods: The clinical study included 50 patients having cardiorespiratory comorbidity with a median age of 66 years who were admitted to the clinic of the Far Eastern Federal University for planned CABG in conditions of ABC. The patients were divided into 2 groups by random sampling method. The first group consisted of 25 patients who underwent low-volume artificial lung ventilation (ALV) with inhalation of nebulized budesonide during ABC; the second – 25 patients underwent isolated low-volume ALV during ABC. The study was carried out in three stages: before the start of ABC, after its completion and a day after CABG. Extravascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were registered using method of transpulmonary thermodilution. Oxygen transport indicators were determined: oxygen delivery index (DO2I) and oxygen consumption index (VO2I), pulmonary blood bypass fraction (Qs/Qt), oxygenation index (OI).Results: After turning off ABC in the first group, the ELWI decreased by 23%, in the second group it declined by 8%. Among patients treated with budesonide, PVPI significantly decreased after providing ABC. However among patients of the second group it remained unchanged. DO2I remained in the reference range among all patients. However VO2I was below it with a minimum value in the second group after ABC stopping. In this cohort the level of Qs/Qt was significantly higher, and OI was lower than in patients of the first group. The resistance of the lung tissue decreased on the background of an increase in its compliance among patients who received budesonide immediately after ABC and 2 hours after it. In the second group there was opposite dynamics of these indicators.Conclusions:The combination of low-volume ALV and inhalation of nebulized budesonide during ABC stabilizes the volemic status of the lungs, improves their oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

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Volemic and Hemodynamic Status of Patients With Comorbidity of Coronary Heart Disease and Chronic Obstructive Pulmonary Disease Before and After Myocardial Revascularization

Cited by 4 publications

References 13 publications

Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Lungs volume status and oxygen transport in patients with coronary artery disease with various types of comorbidity before and after coronary artery bypass grafting

Comparative analysis of intraoperative lung protection technologies in patients having cardiorespiratory comorbidity during coronary bypass surgery with artificial circulation

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