Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Abstract

Objective: To compare the outcomes of 6m/kg vs. 8 ml/kg tidal volume in the lung protective ventilation - low tidal volume strategy in coronary artery bypass grafting operation. Methods: Thirty-two patients enrolled in a randomized, single-center, prospective study were divided into two groups. The outcomes of 6m/kg vs. 8 ml/kg were compared. Arterial blood pressures, heart rate, central venous pressure, expired tidal volume, respiratory frequency, the alveolar minute ventilation, the inspiratory time, static compliance, peak airway pressure, plateau pressure, driving pressure, arterial blood gas data and PaCO2-EtCO2 difference were recorded at T1 (15 min. prior to CPB), T2 (15 min. following the termination of cardio pulmonary bypass), and T3 times (at the end of the surgery). PaO2/FiO2 ratio was recorded at T1, T2 and T3 and 6th (T4) and 12th hours (T5) after extubation. Results: In Group 6ml/kg, extubation time and length of stay in the intensive care unit were significantly longer (p<0.001, p=0.001, respectively). Discharge times were similar in both groups. In group 6ml/kg, PaCO2 was high at all times (T1, T2, T3; p=0.002, p=0.004, p=0.001, respectively), Hemodynamic changes had a similar course in both groups, in Group 6ml/kg. The PaO2/FiO2 ratio was significantly higher in Group 8ml/kg at T2 (p=0.009) and similar at other times. Conclusion: Mechanical ventilation with a low tidal volume strategy with 8 ml/kg has more favorable outcomes by considering the shorter extubation time and length of stay in the intensive care unit comparing with 6 ml/kg.