Comparative Study of Volume Controlled Ventilation Mode (VCV) and Pressure Controlled Ventilation Mode (PCV) Intra Operatively in Patient Undergoing Coronary Artery Bypass Graft Surgery (original) (raw)
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Journal of Clinical Monitoring and Computing, 2016
Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.
Journal of Cardiovascular and Thoracic Research
Introduction: This study aimed to evaluate the effects of high positive-end expiratory pressure (PEEP) and low tidal volume (TV) and recruitment maneuver, on postoperative pulmonary complications (PPCs) after coronary artery bypass grafting (CABG) surgery. Methods: This study is a randomized double blind clinical trial on 64 patients who were undergoing CABG surgery, and were randomly divided into two groups of conventional ventilation (C-Vent) with TV of 9 mL/kg and PEEP=0 cm H2O, and lung protective ventilation (P-Vent), with 6 mL/ kg TV and PEEP=10 cm H2O with recruitment maneuver every 30 minutes. Measures of PPCs and modified clinical pulmonary infection score (mCPIS), were assessed for the first 24 hours of postoperative time in order to evaluate the pulmonary complications. Results: P-Vent with 31 patients and C-Vent with 30 patients, participated in the stage of data analysis. Demographic, and preoperative laboratory results showed no significant difference between two groups. During surgery, cardiovascular complications were higher in P-Vent group (P = 0.61) but pulmonary complications were higher in C-Vent group (P = 0.26). Extubation time was not significantly different between two groups, and also components of arterial blood gases (ABG) of 24 hours after surgery showed no significant difference between the two groups. Pathologic changes in the chest X-ray (CXR) of 24 hours after surgery, were lower in P-Vent group, but the difference was not significant (P = 0.22). The PPC criteria was less positive in P-Vent (2 patients) vs 9 patients in C-Vent group (P = 0.02) and mCPIS score was significantly lower in P-Vent group (1.2 ± 1.4) than C-Vent group (2 ± 1.6) (P = 0.048). Conclusion: Lung protective strategy during and after cardiac surgery, reduces the postoperative mCPIS in patients undergoing open heart surgery for CABG.
Ventilatory profile of patients undergoing CABG surgery
Objective: To assess the ventilatory, radiological and clinical profile of patients undergoing elective CABG in a cardiology reference hospital in South Brazil. Methods: This study included 108 patients undergoing elective CABG surgery, in the period between April 2006 and February 2007 at the Cardiology Institute of Rio Grande do Sul (IC-FUC). The surgical procedure involved median sternotomy, and the saphenous vein and/or internal mammary artery were used for grafting. Lung volume and capacity, as well as the possible existence of ventilatory changes, were assessed by spirometry, and the ventilatory muscle strength was assessed using a vaccum manometer. All evaluations were performed on the preoperative period and on the sixth postoperative day. Health Sciences of Porto Alegre -UFCSPA. Full Professor of the Postgraduation Program and Head Physician of the Electrophysiology Service of the IC/FUC. Results: Preoperative levels of FEV 1 and FVC were significantly reduced on the 6 th postoperative day (P<0.001) when compared to the preoperative levels. A significant decrease of ventilatory muscle strength, expressed as maximum inspiratory and expiratory pressures (MIP and MEP), was also observed from the pre-to the sixth postoperative day (P<0.001). Pulmonary events were more frequent on the 6 th postoperative day (78%) than on the 1 st postoperative day (40%). Conclusions: Patients undergone CABG surgery present important reduction in pulmonary volume and capacity, as well as on the ventilatory muscle strength during the postoperative period. Descriptors: Myocardial revascularization. Spirometry. MORSCH, KT ET AL -Ventilatory profile of patients undergoing CABG surgery Rev Bras Cir Cardiovasc 2009; 24(2): 180-187
Comparison of Pulmonary Gas Exchange in OPCAB Versus Conventional CABG
Heart, Lung and Circulation, 2004
Background. Cardiopulmonary bypass has been implicated as a cause of acute lung injury in cardiac surgical patients. This could be avoided with off-pump coronary artery bypass surgery. Aim. To ascertain the possible benefit of OPCAB surgery on pulmonary gas exchange. Methods. We randomized 75 consecutive patients (mean age 57 years) into two groups: Group 1 off-pump coronary artery bypass surgery (OPCAB), n = 37, Group 2 conventional coronary artery bypass grafting (con CABG), n = 38. Alveolararterial oxygen difference (A-aO 2 difference) was calculated pre-operatively, then 2 and 4 h post-operatively. PaO 2 /FiO 2 ratio and respiratory index (RI) were calculated 2 and 4 h post-operatively. Results. Alveolar-arterial O 2 gradient sharply increased in the immediate post-operative period, from 27 mmHg preoperatively, to 227 mmHg 2 h post-operatively, then declined to 152 mmHg 4 h post-operatively. PaO 2 /FiO 2 ratio and RI also showed severe worsening 2 h post-operatively, with marked improvement at 4 h. The pattern of physiological deterioration of gas exchange was similar in both the groups. Conclusion. In terms of pulmonary gas exchange, similar degree of deterioration is noticed in CABG patients with or without cardiopulmonary bypass. OPCAB seems to provide no physiological benefit of gas exchange at the alveolar capillary membrane when compared to conventional CABG.
Prolonged Mechanical Ventilation After CABG: Risk Factor Analysis
Journal of cardiothoracic and vascular anesthesia, 2015
Prolonged ventilation (PV) after coronary artery bypass graft (CABG) surgery is a common postoperative complication. Preoperative and operative parameters were evaluated in order to identify the patients at risk for prolonged ventilation postoperatively in coronary artery bypass graft (CABG) patients. Retrospective. Research and training hospital, single institution. The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients. The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis. Forty-six patients (5.6%) required PV postoperatively. Hospital mortality was significantly higher in this group (45.7% v 4.0%; p = 0.0001). Univariate analysis showed that these patients were older (65.6±9.3 v 60.4±9.9; p = 0.001), had higher incidences of cerebrovascular disease (21.7% v 10.5%; p = 0.032), advanced ASA (58.7% v 41.8%; p = 0.026) and NYHA classes (32.6% v 12.2%; p = 0.00...
The Effect of the Cross Clamp Time on the Post Operative Ventilation in Post Cabg Patients
2018
Correspondence: Mohamed Ezzeldin Azzam, Cardiothoracic surgery Department, Kasr Ainy Medical School, Cairo University, Egypt, E.Mail: dr.mohamed.ezzazzam@gmail.com ABSTRACT Background: Coronary artery bypass grafting using cardio pulmonary bypass is a successful procedure in modern medicine; however, prolonged aortic cross clamp time is linked to adverse outcome following cardiac surgery. During aortic cross clamping, a period of global myocardial ischemia is followed by reperfusion injury that manifests as myocardial stunning, arrhythmia and changes in cardiac performance that needs inotropic support in early post-operative period, also associated with acute lung injury that needs mechanical ventilation of different duration. Objectives: To assess the effect of the aortic cross clamp time on the mechanical ventilation postoperatively. Patient and methods: Thirty elective patients of isolated ischemic heart disease undergoing on pump CABG, were collected from Cardio Thoracic Surgery...
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).
Archives of Anesthesia and Critical Care
Background: Control of pulmonary ventilation during surgery, especially heart surgery, is very important. Therefore, in this study, we will compare different ventilation strategies during cardiopulmonary bypass in smokers undergoing cardiac surgery. Methods: A total of 42 patients who had a clinical indication for CABG were included in this study. Patients were randomly divided into two groups. All patients were operated on by the same surgeon and cardiac anesthesia team in the same condition. The patient data includes age, sex, height, weight, and spirometry indices (FEV1, FVC, FEV1 / FVC, MMEF, PEF, PaO2, PaCO2, PaO2 / fio2, PaO2 / fio2, and Pent. T) were recorded prospectively for each patient. Results: Examines the spirometry indices of patients in the two groups in both pre-procedure and off-pump time, do not show significant changes (P<0.005). Conclusion: The use of different ventilation strategies in smokers undergoing CABG surgery could not cause significant changes in ...
The journal of Tehran Heart Center, 2010
Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB). In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics. This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volume (TV) = 3 ml/kg, respiratory rate (RR) = 12/min, fraction of inspiratory oxygen (FIO(2))= 1.0, positive end expiratory pressure (PEEP) = 5 cmH(2)O] was applied during CPB (group I); and in the other 50 patients (group II), the lungs were open to the atmosphere without ventilation. Measurements were taken preoperatively, after CPB, and before discharge. Post-bypass PaO(2) (just after CPB 85 versus75) was higher significantly in group I (P value < 0.05). Decrease in postoperative forced expiratory volume in 1 seco...