Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation
Objective: to study the time course of changes in the respiratory biomechanics, extravascular water of the lung (EVWL) and its oxygenizing function and their relationship at different stages of surgical interventions under extracorporeal circulation (EC). Subjects and methods. 29 patients aged 37 to...
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| Format: | Article |
| Language: | English |
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2007-06-01
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| Series: | Общая реаниматология |
| Online Access: | https://www.reanimatology.com/rmt/article/view/1012 |
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| author | I. A. Kozlov A. A. Romanov |
| author_facet | I. A. Kozlov A. A. Romanov |
| author_sort | I. A. Kozlov |
| collection | DOAJ |
| description | Objective: to study the time course of changes in the respiratory biomechanics, extravascular water of the lung (EVWL) and its oxygenizing function and their relationship at different stages of surgical interventions under extracorporeal circulation (EC). Subjects and methods. 29 patients aged 37 to 72 years were examined during uncomplicated operations under EC. The parameters of artificial ventilation (AV) and lung biomechanics were recorded in real time on a Servo-I monitoring apparatus. PaO2/FiO2, Qs/Qt, and body mass index (BMI) were calculated. The EVWL index (EVWLI) was determined by the transpulmonary thermodilution technique. Studies were conducted at stages: 1) after tracheal intubation and the initiation of AV; 2) before sternotomy; 3) after sternal uniting at the end of surgery. Results. Pressures in the airways and their resistance were statistically significantly unchanged. There were significant reductions in Cdyn and Cst at the end of surgery (Stage 3). The mean values of PaO2/FiO2, Qs/Qt, and EVWLI did not undergo considerable changes. There was a significant correlation between PaO2/FiO2 and Qs/Qt (r=-0.5 to -0.8; p<0.05). At Stage 1, BMI proved to be a significant predictor of the level of PaO2/FiO2 and Qs/Qt (r=-0.5 and 0.65; p<0.05). A significant moderate relationship between Qs/Qt and Cdyn was found at Stage 3 (r=-0.44; p<0.05). There were no statistically significant correlations between the parameters of respiratory biomechanics, PaO2/FiO2, Qs/Qt, and EVWLI. At the end of surgery, pulmonary oxygenizing dysfunction (POD) was detected in 5 (17.2%) patients with increased BMI. Alveolar mobilization with a steady-state effect was used to correct POD. Conclusion. When cardiac surgery is uncomplicated and the AV and EC protocols are carefully followed, the rate of intraoperative POD is not greater than 20%, its leading causes are obesity and, most likely, microatelectasis under AV. Key words: pulmonary oxygenizing dysfunction, extracorporeal circulation, extravascular water of the lung, artificial ventilation, cardiosur-gical patients, pulmonary complications. |
| format | Article |
| id | doaj-art-7fcb3a5d5caa4b4789f170aab806ff81 |
| institution | DOAJ |
| issn | 1813-9779 2411-7110 |
| language | English |
| publishDate | 2007-06-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
| record_format | Article |
| series | Общая реаниматология |
| spelling | doaj-art-7fcb3a5d5caa4b4789f170aab806ff812025-08-20T03:18:50ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102007-06-013310.15360/1813-9779-2007-3-171012Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal CirculationI. A. KozlovA. A. RomanovObjective: to study the time course of changes in the respiratory biomechanics, extravascular water of the lung (EVWL) and its oxygenizing function and their relationship at different stages of surgical interventions under extracorporeal circulation (EC). Subjects and methods. 29 patients aged 37 to 72 years were examined during uncomplicated operations under EC. The parameters of artificial ventilation (AV) and lung biomechanics were recorded in real time on a Servo-I monitoring apparatus. PaO2/FiO2, Qs/Qt, and body mass index (BMI) were calculated. The EVWL index (EVWLI) was determined by the transpulmonary thermodilution technique. Studies were conducted at stages: 1) after tracheal intubation and the initiation of AV; 2) before sternotomy; 3) after sternal uniting at the end of surgery. Results. Pressures in the airways and their resistance were statistically significantly unchanged. There were significant reductions in Cdyn and Cst at the end of surgery (Stage 3). The mean values of PaO2/FiO2, Qs/Qt, and EVWLI did not undergo considerable changes. There was a significant correlation between PaO2/FiO2 and Qs/Qt (r=-0.5 to -0.8; p<0.05). At Stage 1, BMI proved to be a significant predictor of the level of PaO2/FiO2 and Qs/Qt (r=-0.5 and 0.65; p<0.05). A significant moderate relationship between Qs/Qt and Cdyn was found at Stage 3 (r=-0.44; p<0.05). There were no statistically significant correlations between the parameters of respiratory biomechanics, PaO2/FiO2, Qs/Qt, and EVWLI. At the end of surgery, pulmonary oxygenizing dysfunction (POD) was detected in 5 (17.2%) patients with increased BMI. Alveolar mobilization with a steady-state effect was used to correct POD. Conclusion. When cardiac surgery is uncomplicated and the AV and EC protocols are carefully followed, the rate of intraoperative POD is not greater than 20%, its leading causes are obesity and, most likely, microatelectasis under AV. Key words: pulmonary oxygenizing dysfunction, extracorporeal circulation, extravascular water of the lung, artificial ventilation, cardiosur-gical patients, pulmonary complications.https://www.reanimatology.com/rmt/article/view/1012 |
| spellingShingle | I. A. Kozlov A. A. Romanov Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation Общая реаниматология |
| title | Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation |
| title_full | Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation |
| title_fullStr | Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation |
| title_full_unstemmed | Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation |
| title_short | Respiratory Biomechanics, Intrapulmonary Water, and Pulmonary Oxygenizing Function During Uncomplicated Operations under Extracorporeal Circulation |
| title_sort | respiratory biomechanics intrapulmonary water and pulmonary oxygenizing function during uncomplicated operations under extracorporeal circulation |
| url | https://www.reanimatology.com/rmt/article/view/1012 |
| work_keys_str_mv | AT iakozlov respiratorybiomechanicsintrapulmonarywaterandpulmonaryoxygenizingfunctionduringuncomplicatedoperationsunderextracorporealcirculation AT aaromanov respiratorybiomechanicsintrapulmonarywaterandpulmonaryoxygenizingfunctionduringuncomplicatedoperationsunderextracorporealcirculation |