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 ➤ Клиническая физиология кровообращения, 2015, №4 ➤ Предупреждение развития нарушений функции легких в ближайшем послеоперационном периоде у больных, оперированных на восходящей аорте с расширением вмешательства на дугу аорты

Prevention of lung function violations in the near postoperative periodin operated on the ascending aorta with expansion of interventionson the aortic arch

Authors: E.S. Nikitin 1 , V.A. Mironenko 1 , S.V. Rychin 1 , N.B. Vyganovskaya 1 , I.M. Makrushin 2 , S.L. Gordeev 1

Company:
1 A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 N.I. Pirogov Russian National Research Medical University, Ministry of Health of the RF, ul. Ostrovityanova, 1, Moscow, 117997, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2015; (): -

Quote as: Nikitin E.S., Mironenko V.A., Rychin S.V., Vyganovskaya N.B., Makrushin I.M., Gordeev S.L.. Prevention of lung function violations in the near postoperative period in operated on the ascending aorta with expansion of interventions on the aortic arch. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2015; 4: 53-59 (in Russ.)

Keywords:  respiratory failure impaired lung function pulmonary oxygenizing dysfunction precapillary artery-arterial (bronchial artery – pulmonary artery) anastomoses cardiac surgery postoperative complications

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Abstract

Objective. Introduction of techniques able to prevent or significantly minimize the development of respiratory failure (impaired lung diffusion capacity) in the immediate postoperative period in patients after surgery on the ascending aorta with extension of the intervention on the aortic arch.

Material and methods. The basis of this research were the materials of clinical observations of 20 patients conducted in the immediate postoperative period after surgery on the ascending aorta with expansion of interventions on the aortic arch from 2013 to 2015. During the conducted studies were performed measurements reflecting the indicators of PO2 and SO2 in the arterial and venous blood, as well as central hemodynamic parameters. The measurements were performed during the first two days after surgery: while the admission of the patient from the operating room and then every 12 hours (twice daily). Each patient been executed four times in all.

Results. Measures taken to reduce the extent of damage of the lung parenchyma during the extracorporeal circulation and especially during circulatory arrest in the examined patients, helped to keep the index of oxygenation in the immediate postoperative period at a satis high level. This figure for the two previous days was not reduced below the mark of 282.7 ± 11.7.

Conclusion. In our opinion mechanical lung ventilation (MLV) used during artificial blood circulation, in patients operated on the ascending aorta with the expansion of intervention on the aortic arch is able to change radically the situation and to prevent the reperfusion injury of alveolar-capillary membrane during the correction of the defect of ischemia and in future. The index of oxygenation in the immediate postoperative period is significantly higher in the group of patients with using MLV during surgical intervention. Even the use of CPAP mode during artificial blood circulation leads to significant increase of oxygenizing lung function. Indeed, damage of alveolar connections and respiratory bronchioles, likely to occur in some patients (in whom the circulatory arrest time exceeds 60 min), however, stored during mechanical ventilation of the alveoli will be capable of providing a sufficient diffusion capacity of the lung in the immediate postoperative period in this group of patients.

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