Pressure-Controlled Mechanical Ventilation Is More Advantageous in the Follow-up of Patients with Chronic Obstructive Pulmonary Disease after Open Heart Surgery
DOI:
https://doi.org/10.1532/HSF98.2013236Abstract
Objective: Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population.
Patients and Methods: Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups.
Results: Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ.
Conclusion: There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.
References
Ca?li K, Ula? MM, Ozi?ik K, et al. 2005. The intraoperative effect of pentoxifylline on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass. Perfusion 20:45-51.nCampbell RS, Davis BR. 2002. Pressure-controlled versus volume controlled ventilation: does it matter? Respir Care 47:416-26.nChiumello D, Pelosi P, Calvi P, Calvi E, Bigattello LM, Gattinoni L. 2002. Different modes of assisted ventilation in patients with acute respiratory failure. Eur Respir J 20:925-33.nCimen S, Ozkul V, Ketenci B, et al. 2003. Daily comparison of respiratory functions between on-pump and off-pump patients undergoing CABG: Eur J Cardiothorac Surg. 23:589-94.nCinella G, Conti G, Lafosa F, et al. 1996. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Care Med 153:1025-33.nClark SC. 2006. Lung injury after cardiopulmonary bypass. Perfusion 21:225-8.nDavidson AC. 2002. The pulmonary physician in critical care 11: critical care management of respiratory failure resulting from COPD. Thorax 57:1079-84.nGao D, Grunwald GK, Rumsfeld JS, et al. 2003. Variation in mortality risk factors with time after coronary artery bypass graft operation. Ann Thorac Surg 75:74-81.nGerrah R, Elami A, Stamler A, Smirnov A, Stoeger Z. 2005. Preoperative aspirin administration improves oxygenation in patients undergoing coronary artery bypass grafting. Chest 127:1622-6.nGrover FL. 1990. Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. Ann Thorac Surg 50:12-26.nGruber PC, Gomersall CD, Leung P, et al. 2008. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology 109:81-7.nHattler BG, Madia C, Johnson C, et al. 1994. Risk stratification using the Society of Thoracic Surgeons Program. Ann Thorac Surg 58: 1348-52.nKaraiskos TE, Palatianos GM, Triantafillou CD, et al. 2004. Clinical effectiveness of leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease. Ann Thorac Surg 78:1339-44.nMunoz J, Guerrero JE, Escalante Jl, Palomino R, De La Calle B. 1993. Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow. Crit Care Med 21:1143-8.nOnorati F, Cristodoro L, Bilotta M, et al. 2006. Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease. Ann Thorac Surg 82:35-43.nRahman A, Ustünda B, Burma O, Ozercan IH, Cekirdekçi A, Bayar MK. 2000. Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass? Eur J Cardiothorac Surg 18:583-8.nRoques F, Nashef SA, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816-22.nSamuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. 1998. Coronary artery bypass grafting in patients with COPD. Chest 113: 878-82.nSchlensak HH. 2002. Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy. Ann Thorac Surg 74: 1167-72.nTireli E, Ugurlucan M, Basaran M, et al. 2006. Extracardiac Fontan operation without cardiopulmonary bypass. J Cardiovasc Surg (Torino) 47:699-704.nUgurlucan M, Arslan AH, Yildiz Y, Cicek S. 2013. On-pump Fontan versus off-pump Fontan in patients with critical pulmonary status. Interact Cardiovasc Thorac Surg 16:700.nUgurlucan M, Nisli K, Tireli E, Dayioglu E. 2008. Off-pump total cavopulmonary connection in a patient with hypoplastic right pulmonary artery and right lung secondary to kyphoscoliosis. J Card Surg. 23:565-8.n
