Intraoperative Pulmonary Protection in the Surgical Treatment of Patients with Infective Endocarditis Complicated by Respiratory Failure

A.B. Koltunova

Abstract


Saving function of the pulmonary circulation for a period of cardiopulmonary bypass is controversial moment in protocols for anesthetic management of cardiac surgeries. The desirability of maintaining blood flow in the pulmonary artery is based on the following facts: the initial lung lesion in all patients with infective endocarditis; feeding components of microvasculature of the lung parenchyma by O2 alveolar air; finding ways to remove activated neutrophils during cardiopulmonary bypass to reduce the severity of lung injury. Objective. Evaluating the effectiveness of methods for intraoperative lung protection under different protocols of anesthetic management in the surgical treatment of patients with infective endocarditis complicated by respiratory failure. Materials. Analysis of the effectiveness of methods to protect the lungs was performed in 151 patients — standard (n = 80) and new (n = 71) protocols. Modified protocol of intraoperative management of patients with infective endocarditis differed from standard one by preservation of lung ventilation (tidal volume of 4 ml/kg, FiO2 0.3, respiratory rate — 4 per 1 min) and a.pulmonalis perfusion by arterial blood through the arterial side branch line without additional pumping device for the period of cardioplegic cardiac arrest. Results. Duration of mechanical ventilation decreased from 18.4 ± 1.9 h to 13.5 ± 1.3 h (p = 0.028). Recording frequency of postoperative respiratory failure decreased from 6.3 % (2010) to 2.8 % (2012). Conclusions. Introduction of lung protection methods has reduced the frequency of postoperative respiratory failure.

Keywords


infective endocarditis; respiratory failure; lung protection

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DOI: https://doi.org/10.22141/2224-0586.5.60.2014.83538

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