Abstract
Cardiopulmonary bypass (CPB) alters pulmonary function and its duration is related to postoperative problems. The lung is the first organ to initiate a clinical response to this inflammatory reaction, translated as an acute lung injury, with ventilation, oxygenation and pulmonary mechanics alterations. The aim of this study was to investigate the immediate changes in lung function after a prolonged (more than 2 h) CPB in cardiac surgeries. Twelve patients (36-85 years; 56-92 kg) were studied before (B) and after (A) CPB. Respiratory monitoring was achieved by intermittent measurements of arterial blood gases, dead space ventilation (VD/VT), and continuous evaluation of expired carbon dioxide (PETCO2), CO2 flow (VCO2), inspired fraction of oxygen (FiO2) and expired tidal volumes (VT), minute ventilation/kg weight (VE/Kg), inspiratory and expiratory flows, pressures and mechanics (static compliance-CSt), utilizing a solid state/single beam nondispersal infrared unit-main stream capnography with a fixed orifice differential pressure pneumotach (CO2SMO-PLUS-Novametrix). PaO2/FiO2 was calculated. Data were gathered before and after CPB, with the chest closed and stable hemodynamics. Normality was evaluated by Kolmogorov-Smirnov test, modified by Lilliefors. Equal variances were assessed by Levene median test. Comparisons between the groups were performed by Student's t-test and Mann-Whitney Rank Sum test. Significance level was 5%. The mean CPB time was 151.08 ± 38.85 (120-245 min). There were no statistical differences in VE/kg (87.08 ± 14.54 versus 88.24 ± 12.31), FiO2 (0.47 ± 0.4 versus 0.50 ± 0.4), WmOB (1.34 ± 0.5 versus 1.34 ± 0.4), RawI, RawE, Cdyn and VD/VT. There were significant differences in PaO2 (153.72 ± 61.11 versus 106.90 ± 38.43), pH (7.46 ± 0.06 versus 7.39 ± 0.09), PaCO2 (33.86 ± 6.47 versus 40.47 ± 7.85) and CSt (47.60 ± 14.90 versus 42.08 ± 12.80). Thus, in patients after prolonged CPB, the only change in pulmonary mechanics was the static compliance values. On the other hand, oxygenation was greatly impaired. An increase in CO2 values was seen despite the same minute ventilation and VD/VT ratio, probably due to a high VCO2.
Highlights
Propranolol plasma levels and pharmacokinetics (PK) may be altered by cardiopulmonary bypass (CPB)
Analysis of data from a retrospective study of long distance aeromedical transports performed by Montreal-based Skyservice Lifeguard transport service. (A manuscript describing this study has been accepted for publication in the journal Aviation, Space, and Environmental Medicine.) For patients transported by Lear Jet air ambulance post myocardial infarction (MI), potential risk factors examined included age, gender, Killip class, revascularization procedures, and status at time of transportation
TST was positive for myocardial ischemia in 22% of 82 patients initially classified as intermediate probability of acute myocardial infarction (AMI)/unstable angina (UA), and in 9% of 186 patients classified as low probability (P = 0.004)
Summary
Propranolol plasma levels and pharmacokinetics (PK) may be altered by cardiopulmonary bypass (CPB). The objective of our study was to assess the effect of different levels of airway pressure on lung morphology by performing a LRM during the lung CT-scan This way, we could set the best ventilatory strategy for the patient and identify the mechanisms involved during the LRM. The goal of this study was to determine the incidence of thrombocytopenia and the correlation with length of ICU stay, mortality rate, admission severity scores APACHE II and SAPS II, and multiple organ dysfunction scores SOFA and LODS. Multiple organ dysfunction has been recognized as a major factor associated with mortality in patients with acute respiratory failure (ARF). Purpose: The objectives of this study are (1) to describe demographics, clinical features, physiologic parameters, and prognosis of patients on mechanical ventilation admitted to the Intensive Care Unit of Hospital Moinhos de Vento; and (2) to identify predictors of mortality and ventilator time. Percutaneous access is an option in such patients, and the clinical staff can perform it
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