Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Abstract

Lung protection during surgeries with artificial circulation (AC) is a vital task in clinical medicine.The aim. Evaluation of the effectiveness of intraoperative administration of nebulized budesonide for correcting the volume status of the lungs and oxygen transport in patients with concomitant coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).Methods. The pilot clinical study included 40 patients with concomitant CHD and COPD who were admitted for scheduled CABG with AC. The first groups consisted of 20 patients who underwent low-volume artificial lung ventilation (AVL) with inhalation of nebulized budesonide in the process of AC; the second group consisted of 20 patients who underwent AC according to a routine technique with AVL off. Lung volemic status parameters were recorded by transpulmonary thermodilution using the Pulsion PiCCO in three stages: before the onset of AC, after its completion and one day after AC.Results. It was established that after withdrawal from AC, indices of extravascular water in the lungs (IEWL) decreased by 23% in the first group and increased by 24% in the second group. After the completion of AC and a day after it, IEWL significantly decreased in patients receiving budesonide and increased with a maximum rise at the second stage of the study in the second group. The index of oxygen delivery and utilization over time was within the reference range in all patients. The index of oxygen consumption did not reach the physiologically normal lower limit. The maximum level of pulmonary bypass blood fraction (16 and 12%, respectively) and a significant decrease in oxygenation index (240 – 290 c. u.) were recorded in this cohort of patients at the 2nd and 3rd stages of the study. The duration of postoperative ventilation was significantly longer in the second group, while the duration of in-hospital treatment did not differ significantly before the groups.Conclusion. The protective effects of the combination of aerosol therapy with budesonide and low-volume AVL were manifested by a decrease in the permeability of the pulmonary capillaries, the volume of IEWL, an improvement in the oxygenating function of the lungs, a decrease in the number of respiratory complications and the postoperative duration of AVL.