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


Mechanical ventilation in prone-position and setting optimal РEEР by transpulmonary pressure in a patient with a reduced left ventricular ejection fraction and respiratory failure in the early postoperative period

Authors: Leushin K.Yu., Rybka M.M., Donakanyan S.A., Raynes E.V., Mironenko V.A.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2022-19-2-160-167

UDC: 616-083.98:616.124.2]-089.1

Link: Clinical Physiology of Blood Circulaiton. 2022; 2 (19): 160-167

Quote as: Leushin K.Yu., Rybka M.M., Donakanyan S.A., Raynes E.V., Mironenko V.A. Mechanical ventilation in proneposition and setting optimal РEEР by transpulmonary pressure in a patient with a reduced left ventricular ejection fraction and respiratory failure in the early postoperative period. Clinical Physiology of Circulation. 2022; 19 (2): 160–7 (in Russ.). DOI: 10.24022/1814-6910-2022-19-2-160-167

Received / Accepted:  18.02.2022 / 15.03.2022

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Abstract

The patient, after the Bentall–De Bono operation with the imposition of Kabrol anastomosis, had a low cardiac output syndrome under ventilator conditions, and hypoxemia was noted. To increase oxygenation, a method was chosen to adjust the optimal level of РEEР by transpulmonary pressure under the control of central hemodynamic parameters. When selecting the optimal level of РEEР, at which Ptp PEEP ≥ 0, in the supine position, oxygenation increased by 50%, however, an increase in left ventricular preload was noted, which was accompanied by a decrease in cardiac output, oxygen delivery and a decrease in tissue perfusion. In the prone-position, oxygenation increased by more than 3 times, while the optimal РEEР was 2 times lower, in conditions of normovolemia, optimal preload for left ventricle, normokinetic type of hemodynamics with increased oxygen transport and improved tissue perfusion were provided. In the prone position, the alveolar-arterial difference in oxygen tension (AaDO2) and shunt fraction (Qs/Qt) decreased. After 16 hours spent in the prone-position in a protective ventilator, an increase in the ejection fraction of the left ventricle was noted.

About Authors

  • Konstantin Yu. Leushin, Resuscitator; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology; ORCID
  • Sergey A. Donakanyan, Dr. Med. Sci., Head of Department of Intensive Care Unit;
  • Elena V. Raynes, Resuscitator;
  • Vladimir A. Mironenko, Dr. Med. Sci., Head of Department of Reconstructive Surgery and Aortic Root; ORCID

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