Clinical Physiology of Circulation

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


Respiratory failure in immediate postoperative period caused by lung recruitment maneuver in patients who underwent open heart surgery

Authors: L.A. Bockeria 1, E.S. Nikitin 1, G.P. Kiryushchenkov 2

Company:
1 A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences, Rublevskoe shosse, 135, Moscow, 121552, Russia;
2 Federal Scientific-Clinical Center of the Federal Medical-Biological Agency of Russia, Orekhovyy bul'var, 28, Moscow, 115682, Russia

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Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

As a rule, decrease of oxygenation index in the immediate postoperative period in cardiac patients is related to the impaired pulmonary diffusion capacity which can be the consequence of untimely or inadequate repair of cardiac pathology. This can lead to the deposition of large amounts of fluid in the pulmonary interstitial space. Therefore, the duty of an intensivist is to remove immediately excess fluid from interstitial space and thus to restore pulmonary diffusing capacity.

Regretfully, it often happens that intensivist performs lung recruitment procedure in order to improve function of the lungs in oxygenizing the blood without having examined the reasons for the decline in the partial pressure of oxygen in the blood. As a rule, it has a short-term effect or doesn't result in the increase of oxygenation index at all, as it is impossible to remove interstitial fluid by performing lung recruitment maneuvers. This maneuver can improve function of the lungs in oxygenizing the blood only in case if initially sufficient amount of fluid was removed from interstitial space of the lungs and provided that the patency of bronchial tubes haven't been restored and some parts of alveoli remain in a collapsed state.

Furthermore, pulmonary stretch receptors may be damaged during lung recruitment maneuver when high levels of positive end-expiratory pressure are being maintained. As a result severe respiratory failure can develop which presents with inability of a patient to draw a proper tidal volume, as a consequence prolonged mechanical ventilation will be performed.

References

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