Fischer Marc-Olivier, Courteille Benoît, Guinot Pierre-Grégoire, Dupont Hervé, Gérard Jean-Louis, Hanouz Jean-Luc, Lorne Emmanuel
From the Anesthesiology and Critical Care Department (M-OF, BC, J-LG, J-LH), University Hospital of Caen; EA 4650 (MOF, JLH), Caen Basse-Normandie University, Esplanade de la Paix, Caen; Anesthesiology and Critical Care Department (P-GG, HD, EL), Amiens University Medical Center, Amiens; and INSERM U 1088 (P-GG, HD, EL), University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens cedex, France.
Medicine (Baltimore). 2016 Mar;95(9):e2655. doi: 10.1097/MD.0000000000002655.
Protective ventilation is associated with a lower incidence of pulmonary complications. However, there are few published data on routine pulmonary management in adult cardiac surgery. The present study's primary objective was to survey pulmonary management in this high-risk population, as practiced by anesthesiologists in France. All 460 registered France-based cardiac anesthesiologists were invited (by e-mail) to participate in an online survey in January-February 2015. The survey's questionnaire was designed to assess current practice in pre-, per-, and postoperative pulmonary management. In all, 198 anesthesiologists (43% of those invited) participated in the survey. Other than during the cardiopulmonary bypass (CPB) per se, 179 anesthesiologists (91% of respondees) [95% confidence interval (CI): 87-95] used a low-tidal-volume approach (6-8 mL/kg), whereas techniques based on positive end-expiratory pressure and recruitment maneuvers vary greatly from 1 anesthesiologist to another. During CPB, 104 (53%) [95% CI: 46-60] anesthesiologists withdrew mechanical ventilation (with disconnection, in some cases) and 97 (49%) [95% CI: 42-56] did not prescribe positive end-expiratory pressure. One hundred sixty-five (83%) [95% CI: 78-88] anesthesiologists stated that a written protocol for peroperative pulmonary management was not available. Twenty (10%) [95% CI: 6-14] and 11 (5%) [95% CI: 2-8] anesthesiologists stated that they did use protocols for ventilator use and recruitment maneuvers, respectively. The preoperative period (pulmonary examinations and prescription of additional assessments) and the postoperative period (extubation, and noninvasive ventilation) periods vary greatly from 1 anesthesiologist to another. The great majority of French cardiac anesthesiologists use a low tidal volume during cardiac surgery (other than during CPB per se). However, pulmonary management procedures varied markedly from 1 anesthesiologist to another. There is a clear need for large clinical studies designed to identify best practice in pulmonary management.
保护性通气与较低的肺部并发症发生率相关。然而，关于成人心脏手术常规肺部管理的已发表数据很少。本研究的主要目的是调查法国麻醉医生在这一高风险人群中的肺部管理情况。2015年1月至2月，所有460名注册的法国心脏麻醉医生均被邀请（通过电子邮件）参与一项在线调查。该调查的问卷旨在评估术前、术中及术后肺部管理的当前实践情况。共有198名麻醉医生（占受邀者的43%）参与了调查。除了在体外循环（CPB）期间本身，179名麻醉医生（占受访者的91%）[95%置信区间（CI）：87 - 95]采用低潮气量方法（6 - 8 mL/kg），而基于呼气末正压和肺复张手法的技术在不同麻醉医生之间差异很大。在CPB期间期间，104名（53%）[95% CI：46 - 60]麻醉医生撤掉机械通气（在某些情况下断开连接），97名（49%）[95% CI：42 - 56]未设定呼气末正压。165名（83%）[95% CI：78 - 88]麻醉医生表示没有术中肺部管理的书面方案。分别有20名（10%）[95% CI：6 - 14]和11名（5%）[95% CI：2 - 8]麻醉医生表示他们确实使用了呼吸机使用方案和肺复张手法方案。术前阶段（肺部检查和额外评估的处方）和术后阶段（拔管和无创通气）在不同麻醉医生之间差异很大。绝大多数法国心脏麻醉医生在心脏手术期间（除CPB期间本身外）使用低潮气量。然而，肺部管理程序在不同麻醉医生之间差异显著。显然需要进行大型临床研究以确定肺部管理的最佳实践方法。
