Use of Negative Extrathoracic Pressure to Improve Hemodynamics After Cardiac Surgery (original) (raw)
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Positive End-Expiratory Pressure Ventilation After Open-Heart Surgery
Acta Anaesthesiologica Scandinavica, 1974
Thirty-seven patients were studied after open-heart surgery in relation to the effect of positive end-expiratory pressure ventilation (PEEP) as compared to routine intermittent positive pressure ventilation (IPPV) with the Engstrom Respirator. The patients were divided in two groups with 21 patients receiving PEEP and 16 IPPV. Arterial oxygen tensions and inspiratory oxygen fractions were determined 1 h after surgery and 1 day later. During the first postoperative night, the respirator settings were not changed. Inspired oxygen fractions were kept constant. PEEP between + 5 to + 10 cmHeO was used. In 11 patients, functional residual capacity (FRC) was measured preoperatively and on the first postoperative day. Statistical analyses showed no significant changes in arterial oxygen tension or in the alveolararterial oxygen differences between the two groups. FRC was slightly disminished, but no correlation was found in relation to changes in arterial oxygen tensions. It is concluded that after uneventful open-heart surgery, when careful attention is paid to maintenance of circulation and avoidance of overhydration, PEEP does not have any advantage over IPPV with a volume controlled ventilator. PEEP should, therefore, be reserved for patients with interstitial pulmonary oedema with alveolar "oxygen-block" or those in whom measures to improve pulmonary perfmion have not succeeded.
Journal of Cardiothoracic and Vascular Anesthesia, 1992
echocardiography was used to extend knowledge about the impact of positive end-expiratory pressure (PEEP) during mechanica1 ventilation on right and left ventricular function and right ventricular impedance. At 20 cmHz0 PEEP, a progressive increase of right ventricular end-diastolic area was seen (27%) that coincided with a reduction of early left ventricular filling velocity (25%) across the mitral valve, and a decrease of both pulmonary artery flow velocity (end-expiration 27% and end-inspiration 42%) and time-velocity index (end-inspiration 25%). As these Copyright 0 1992 by W. B. Saunders Company 1053.0770/9210604-0009$3.00/0 changes were not accompanied by a change of the fractional area of contraction, the increase of the right ventricular diameter might be explained by right ventricular compensation due to an imbalance between augmented right ventricular impedance and reduced venous return.
Research in Cardiovascular Medicine, 2013
Background: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an important and common postoperative complication that results into pulmonary dysfunction typically lasting more than a week following surgery. Different methods have been provided to prevent these complications. Objectives: In order to prevent postoperative pulmonary complications, investigation of the effectiveness of continuous positive airway pressure (CPAP) and intermittent mandatory ventilation (IMV) during cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).
Brazilian Journal of Cardiovascular Surgery, 2019
Objective: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). Methods: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH 2 O; Group 12, PEEP of 12 cmH 2 O; and Group 15, PEEP of 15 cmH 2 O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. Results: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre-and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. Conclusion: It is concluded that high levels of PEEP (15 cmH 2 O) are beneficial for the improvement of gas exchange in patients undergoing CABG.
Noninvasive Positive Pressure Ventilation After Cardiac Surgery
Journal of Ankara Medical School, 2005
B Ba ac ck kg gr ro ou un nd d: : We have reported the results obtained by non-invasive positive pressure ventilation (NIPPV) applied to the patients who had an open heart surgery and suffered from respiratory failure after extubation due to various reasons. M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : We applied NIPV support following severe respiratory deterioration in fifteen patients who underwent open heart surgery under cardiopulmonary bypass in our clinic between January 2000 and January 2001. Nine patients (60%) required NIPPV because of acute inflammation of underlying chronic obstructive pulmonary disease (COPD). Remaining six patients (40%) suffered from alveolar hypoventilation despite normal preoperative respiratory function. Despite NIPPV support (avarage 2 to 4 hours), five patients required reentubation due to respiratory failure defined as persistandt hypoxia, hypercapnia and hemodynamic instability. However, respiratory parameters improved significantly in 10 patients and reentubation was avoided. R Re es su ul lt ts s: : Ten patients who did not require reentubation were supported by NIPPV for avarege of 8±5 hours (range 3-18 hours). One patient (6.66%) died as a result of acute respiratory distress syndrome (ARDS) following aspiration pneumonia during the first week of postoperative period. C Co on nc cl lu us si io on n: : NIPPV which is less invasive when compared to endotracheal entubation can be life saving. Timely application of NIPPV also prevents possible complications of endotracheal entubation in the patinets who suffered from respiratory failure that did not require immediate entubation after open heart surgery.
Brazilian journal of cardiovascular surgery
To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and follow...
Journal of Cardiothoracic and Vascular Anesthesia, 2012
Objective: Negative-pressure ventilation (NPV) by external cuirass (RTX; Deminax Medical Instruments Limited, London, UK) in intubated patients after cardiac surgery improves hemodynamics measured by pulmonary artery catheter (PAC)-based methods with increased cardiac output (CO) and stroke volume (SV) without changing the heart rate (HR). The less-invasive pressure recording analytical method (PRAM) (MostCare; Vytech Health srl, Padova, Italy) allows radial artery monitoring of CO, SV, SV variation, and cardiac cycle efficiency (CCE). The authors investigated the hypothesis that NPV improves PRAM-based hemodynamics and arterial blood gas analysis in extubated cardiac surgery patients.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2008
Due to an increasing incidence of respiratory failure after cardiac surgery we wanted to study whether nasal continuous positive airway pressure (NCPAP) may improve pulmonary oxygen transfer and may avoid reintubation after coronary operations. Additionally, we compared this protocol to non-invasive positive pressure ventilation (NPPV). For a period of 2 years we analyzed all patients that were extubated within 12 hours after coronary surgery, and in whom oxygen transfer (PaO2/FIO2) deteriorated without hypercapnia so that all these patients met predefined criteria for reintubation: group A=immediate reintubation (n=88), group B=NCPAP-treatment (n=173), group C=NPPV (n=18). 25.4% of group B- and 22.2% of group C-patients were also intubated after a period of NCPAP or NPPV. All other patients of groups B and C could be weaned from these devices (B = 34.3 +/- 5.9 hours; C = 26.4 +/- 4.4 h; p < 0.05) and were well oxygenated by face mask at ambient pressure (Ratio PaO2/FIO2: B, 138 ...
Archives of Physiotherapy, 2017
Background: Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO 2) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery. Methods: Seventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO 2 /FiO 2 ratio <200) were enrolled. Heart rate, mean arterial pressure, arterial and venous blood samples were measured at intensive care unit and PEEP was increased to 12 cmH 2 O for 30 min. Results: As expected, PEEP12 improved arterial oxygenation and PaO 2 /FiO 2 ratio (p < 0.0001). Reduction in ScvO 2 was observed between PEEP5 (63 ± 2%) and PEEP12 (57 ± 1%; p = 0.01) with higher values of blood lactate in PEEP12 (p < 0.01). No hemodynamic effects (heart rate, mean arterial pressure, SpO 2 ; p > 0.05) were related. Conclusion: Increased PEEP after cardiac surgery decreased ScvO 2 and increased blood lactate, even with higher O 2 delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.