Arslan Murat, Öçmen Elvan, Duru Seden, Şaşmaz Belkis, Özbılgın Şule, Hepağuşlar Hasan
Department of Anesthesiology and Reanimation, Intensive Care Unit, Medical School, Ege University, Izmir, Turkey.
Department of Anesthesiology and Reanimation, Medical School, Dokuz Eylül University, Izmir, Turkey.
Saudi J Anaesth. 2019 Jan-Mar;13(1):40-45. doi: 10.4103/sja.SJA_615_18.
We aimed to investigate the changes in respiratory mechanics in adult patients undergoing open heart surgery (OHS) while using volume-controlled auto-flow (VCAF) ventilation mode.
After obtaining ethics committee's approval and informed consent, 30 patients (17 males and 13 females; mean age: 57.3 ± 17.0 years; mean weight; 74.9 ± 13.6 kg) scheduled for OHS were enrolled. Mechanical ventilation was carried out using VCAF mode (V: 5-8 mL/kg, I/E: 1/2, 10 ± 2 fr/min). Values of dynamic compliance (C) and resistance (R) were obtained at six time points (TPs). Normally distributed variables were analyzed with repeated measure of analysis of variance and Bonferroni tests. For abnormally distributed variables, Friedman variance analysis and Wilcoxon signed-rank tests were used. Values were expressed as mean ± standard deviation. value <0.05 was considered significant.
C (mL/mbar) and R (mbar/L/s) values were as follows - (1) before sternotomy (S): 49.9 ± 17.1 and 7.8 ± 3.6; (2) after S: 56.7 ± 18.3 and 7.1 ± 3.7; (3) after S and after sternal retractor placement: 48.7 ± 16.1 and 8.3 ± 4.4; (4) after weaning from cardiopulmonary bypass and following decannulation while retractor was in place: 49.6 ± 16.5 and 8.1 ± 4.0; (5) after retractor removal: 56.5 ± 19.6 and 7.4 ± 3.7; and (6) after sternal closure: 43.1 ± 14.2 and 9.6 ± 9.1, respectively. Significant differences were observed in C and R between; first and second TPs, second and third TPs, fourth and fifth TPs, and fifth and sixth TPs. Also, significant difference in C was found between first and sixth TPs, but it was not found in R.
C decreases, but R remains the same in cardiac surgical patients when mechanical ventilation is performed with VCAF ventilation mode. Additionally, C is negatively affected by the presence of sternal retractor and the sternal closure in OHS.
我们旨在研究成年心脏直视手术（OHS）患者在使用容量控制自动流量（VCAF）通气模式时呼吸力学的变化。
获得伦理委员会批准并取得知情同意后，纳入30例计划接受OHS的患者（17例男性和13例女性；平均年龄：57.3±17.0岁；平均体重：74.9±13.6 kg）。采用VCAF模式进行机械通气（V：5 - 8 mL/kg，I/E：1/2，10±2次/分钟）。在六个时间点（TPs）获取动态顺应性（C）和阻力（R）值。对正态分布变量采用重复测量方差分析和Bonferroni检验进行分析。对于非正态分布变量，采用Friedman方差分析和Wilcoxon符号秩检验。数据以均值±标准差表示。P值<0.05被认为具有统计学意义。
C（mL/mbar）和R（mbar/L/s）值如下 - （1）胸骨切开术前（S）：49.9±17.1和7.8±3.6；（2）胸骨切开术后：56.7±18.3和7.1±3.7；（3）胸骨切开并放置胸骨牵开器后：48.7±16.1和8.3±4.4；（4）体外循环撤机后且牵开器在位时拔管后：49.6±16.5和8.1±4.０；（5）牵开器移除后：56.5±１9.6和7.4±3.7；（6）胸骨关闭后：43.1±14.2和9.6±9.1。在C和R方面，第一和第二个TPs之间、第二和第三个TPs之间、第四和第五个TPs之间以及第五和第六个TPs之间观察到显著差异。此外，在C方面第一和第六个TPs之间发现显著差异，但在R方面未发现。
在采用VCAF通气模式进行机械通气时，心脏手术患者的C降低，但R保持不变。此外，OHS中胸骨牵开器的存在和胸骨关闭对C有负面影响。
