Effects of off-pump coronary surgery on the mechanics of the respiratory system, lung, and chest wall: Comparison with extracorporeal circulation.

Abstract:

OBJECTIVE:To compare the effects of cardiac surgery with and without extracorporeal circulation on the mechanics of the respiratory system, lung, and chest wall. We also determined the time course of those effects. DESIGN:Prospective, controlled study. SETTING:An eight-bed, cardiac-surgical intensive care unit at a university hospital. PATIENTS:Two groups of patients scheduled for elective coronary bypass surgery were studied: ten patients with extracorporeal circulation and 13 patients without extracorporeal circulation. INTERVENTIONS:Measurement of esophageal pressure after insertion of an esophageal balloon catheter to separate respiratory system mechanics into lung and chest wall components. Measurements were performed preoperatively after induction of anesthesia (control), immediately postoperatively at arrival in the intensive care unit (time 1), and after 3 hrs (time 2). In 12 of the 23 patients, measurements were also performed 6 hrs postoperatively (time 3). MEASUREMENTS AND MAIN RESULTS:No significant differences concerning demographics or surgical procedure were noticed between the two groups. Respiratory system, chest wall, and lung mechanics were obtained using the technique of rapid airway occlusion during constant-flow inflation. In both the group with and without extracorporeal circulation there was a significant increase in static and dynamic elastance of the respiratory system and lung at times 1 and 2, which tended to decrease again at time 3; chest wall elastance significantly increased at times 2 and 3 in the group without extracorporeal circulation, whereas the increase in chest wall elastance in the group with extracorporeal circulation occurred earlier (also at time 1). Additional resistance of the respiratory system and lung remained unchanged; chest wall resistance, however, significantly increased in both groups. Work of breathing significantly increased in both groups at times 1 and 2. There was a significant reduction in the Pao2/Fio2 ratio in both groups at times 2 and 3. No significant differences between the groups at any moment were noticed. CONCLUSIONS:Coronary bypass surgery with and without extracorporeal circulation results in dramatic impairment of respiratory system mechanics. Based on respiratory system mechanics, early extubation after coronary artery bypass grafting should be performed with caution, no matter whether the off-pump or cardiopulmonary bypass technique is used.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Roosens C,Heerman J,De Somer F,Caes F,Van Belleghem Y,Poelaert JI

doi

10.1097/00003246-200211000-00005

subject

Has Abstract

pub_date

2002-11-01 00:00:00

pages

2430-7

issue

11

eissn

0090-3493

issn

1530-0293

journal_volume

30

pub_type

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