Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2019; 16 (3): 165-254 ➤ Настройка параметров послеоперационной респираторной поддержки по транспульмональному давлению у больного с острым расслоением аорты, осложнившимся острым респираторным дистресс-синдромом и синдромом интраабдоминальной гипертензии

Parameter setting of postoperative respiratory supportin transpulmonary pressure in a patient with acute aorticdissection complicated by the acute respiratory distresssyndrome and syndrome of abdominal hypertension

Authors: K.Yu. Leushin, G.V. Yudin, M.M. Rybka, S.A. Donakanyan, V.A. Mironenko

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-3-235-243

UDC: 616.132-007.281-036.11-089.168-06:616.12-089.5-036.82

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (3): 235-243

Quote as: Leushin K.Yu., Yudin G.V., Rybka M.M., Donakanyan S.A., Mironenko V.A. Parameter setting of postoperative respiratory support in transpulmonary pressure in a patient with acute aortic dissection complicated by the acute respiratory distress syndrome and syndrome of abdominal hypertension. Clinical Physiology of Circulation. 2019; 16 (3): 235–43 (in Russ.). DOI: 10.24022/1814-6910-2019-16-3-235-243

Keywords:  acute aortic dissection acute respiratory distress syndrome intraabdominal hypertension esophageal pressure transpulmonary pressure respiratory support

Received / Accepted:  22.05.2019/27.05.2019

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Abstract

The risk of developing acute respiratory distress syndrome (ARDS) in cardiosurgery is 16% and increases in cases of acute aortic dissection up to 50%. In patients with ARDS in the postoperative period, a protective ventilator with a setting of positive end-expiratory pressure (PEEP) by the value of transpulmonary pressure (Ptp > 0), i.e. the difference between the pressure inside and outside the alveoli on inhalation and exhalation. This is done by measuring the pressure in the lower 1/3 of the esophagus (Pes), which is a surrogate of intra-pleural pressure (Ppl). In a patient with ARDS and concomitant intraabdominal hypertension (IAG), setting PEEP to target values of 18–20 mbar was accompanied by inhibition of systemic hemodynamics. In the position on the sides with the raised head end, during the protective ventilation with the target PEEP 14 mbar, a satisfactory oxygenating (PaO2/FiO2 = 230, SpO2 98%) and eliminating CO2 (PaCO2 = 35 mm Hg) lung function was achieved under stable hemodynamics (BP 120/70 mm Hg, HR 70 beats/min, PvO2 43 mm Hg, SvO2 78%). When comparing the parameters of mechanical ventilation in the patient on the supine, at the prescribed 18 mbar PEEP, static compliance of the respiratory system (Cstat) was 43 ml/mbar, and the position of the patient on the side with PEEP 14 mbar Сstat increased to 63 ml/mbar (50%) at safe pressures in the respiratory system inspiratory Pplat = 26 and 22 mbar respectively, and valid Driving Pressure = 9 mbar. The decrease in the compliance of the respiratory system was due to the rigid chest wall Cw = 71–74 ml/mbar. In the complex treatment of intraabdominal hypertension, epidural administration of local anesthetics with the creation of a sympathetic block in the lower thoracic segment of the spinal cord, allowed to reduce intraabdominal pressure from 13 to 10 mm Hg.

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About Authors

  • Konstantin Yu. Leushin, Anesthesiologist-Intensivist; orcid.org/0000-0002-4386-0030
  • Gennadiy V. Yudin, Сand. Med. Sc., Anesthesiologist-Intensivist; orcid.org/0000-0001-9976-6206
  • Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology; orcid.org/0000-0001-8206-8794
  • Sergey A. Donakanyan, Сand. Med. Sc., Head of Department of Intensive Care for Adults;
  • Vladimir A. Mironenko, Dr. Med. Sc., Head of Department of Reconstructive Surgery and Aortic Root; orcid.org/0000-0003-1533-6212

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