Open lung ventilation improves functional residual capacity after extubation in cardiac surgery
Open lung ventilation improves functional residual capacity after extubation in cardiac surgery
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DOI：
10.1097/01.ccm.0000181674.71237.3b
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发表时间：
2005-10-01
影响因子：
8.8
通讯作者：
Gommers, D
中科院分区：
文献类型：
--
作者：
Miranda, DR;Struijs, A;Gommers, D
目的：心脏手术后，拔管后功能残气量（FRC）显着降低。我们假设，根据开放肺概念 (OLC) 的通气会减弱拔管后 FRC 的减少。设计：一项前瞻性、单中心、随机、对照临床研究。地点：一所大学医院的心胸手术室和重症监护室。患者：69 名计划进行选择性冠状动脉搭桥术和/或体外循环瓣膜手术的患者。干预措施：手术前，患者被随机分配到三组：(1) 常规通气（简历）； (2) OLC，到达重症监护室后开始（晚期开放肺）； (3) OLC，插管后立即开始（早期开肺）。在两个 OLC 组中，均应用肺复张操作直至 Pao(2)/Fio(2) > 375 Torr (50 kPa)。 CV 组未应用肺复张操作。测量和主要结果：在术前和拔管后 1、3、5 天测量 FRC。每天测量外周血红蛋白饱和度（点），直到拔管后第三天，当患者呼吸室内空气时。低氧血症由现货值定义
Objective: After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation.Design: A prospective, single-center, randomized, controlled clinical study.Setting: Cardiothoracic operating room and intensive care unit of a university hospital.Patients: Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass.Interventions: Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until Pao(2)/Fio(2) was > 375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group.Measurements and Main Results: FRC was measured preoperatively and 1, 3, and 5 days after extubation. Peripheral hemoglobin saturation (Spot) was measured daily till the third day after extubation while the patient was breathing room air. Hypoxemia was defined by an Spot value