ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2002 August;43(4):419-22

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Peripheral pulmonary atelectasis and oxygentation impairment following coronary artery bypass grafting

Ishikawa S., Takahashi T., Ohtaki A., Sato Y., Suzuki M., Hasegawa Y., Ohki S., Mohara J., Oshima K., Morishita Y.

Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan

Background. Severe pul­mo­nary oxy­gen­a­tion impair­ment ­occurred in ­some ­patients ­with pleu­rot­o­my dur­ing the har­vest of the inter­nal mam­mary ­artery ­graft fol­lowed by cor­o­nary ­artery ­bypass graft­ing (­CABG). Peripheral pul­mo­nary ate­lec­ta­sis in the post­op­er­a­tive ­chest X-ray was detect­ed in ­these ­patients. We stud­ied the effi­ca­cy of intra­op­er­a­tive pos­i­tive end-expir­a­to­ry air­way pres­sure (­PEEP) ther­a­py for the pre­ven­tion of post­op­er­a­tive pul­mo­nary oxy­gen­a­tion impair­ment.
Methods. The pleu­ral cav­ity was intra­op­er­a­tive­ly ­opened in 40 ­patients ­with sol­i­tary ­CABG pro­ce­dure per­formed dur­ing 5 ­years ­since January 1992. These ­patients ­were divid­ed ­into two ­groups. Intraoperative ­PEEP ther­a­py, ­which is initiat­ed ­just ­after pleu­rot­o­my, was not ­used in 32 ­patients ­before May, 1996 (con­trol ­group) and ­used for ­recent 8 ­patients ­with pleu­rot­o­my (­PEEP ­group). The ­mean age of ­patients was 60 ­years old in the con­trol ­group and 68 in the ­PEEP ­group.
Results. Respiratory insuf­fi­cien­cy (A-aDO2 >400 mmHg and RI >1.5) was detect­ed in 6 ­patients in the con­trol ­group. Three out of ­these 6 ­patients ­required ­long-­term mechan­i­cal res­pir­a­to­ry sup­port ­over a ­week. No res­pir­a­to­ry insuf­fi­cien­cy ­occurred in ­patients of the PEEP group. Values of PaO2, A-aDO2, res­pir­a­to­ry ­index and ­shunt ­ratio ­were sig­nif­i­cant­ly ­worse in the con­trol ­group ­than in the ­PEEP ­group.
Conclusions. In con­clu­sion, ­PEEP ther­a­py may pre­vent pul­mo­nary ate­lec­ta­sis and oxy­gen impair­ment ­after ­CABG.