Martinsson Andreas, Houltz Erik, Wallinder Andreas, Magnusson Jesper, Lindgren Sophie, Stenqvist Ola, Thorén Anders
Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
BJA Open. 2022 Nov 21;4:100105. doi: 10.1016/j.bjao.2022.100105. eCollection 2022 Dec.
Cardiac surgery produces dorso-basal atelectasis and ventilation/perfusion mismatch, associated with infection and prolonged intensive care. A postoperative lung volume recruitment manoeuvre to decrease the degree of atelectasis is routine. In patients with severe respiratory failure, prone positioning and recruitment manoeuvres may increase survival, oxygenation, or both. We compared the effects of lung recruitment in prone supine positions on dorsal inspiratory and end-expiratory lung aeration.
In a prospective RCT, 30 post-cardiac surgery patients were randomly allocated to recruitment manoeuvres in the prone (=15) or supine position (=15). The primary endpoints were late dorsal inspiratory volume (arbitrary units [a.u.]) and left/right dorsal end-expiratory lung volume change (a.u.), prone supine after extubation, measured using electrical impedance tomography. Secondary outcomes included left/right dorsal inspiratory volumes (a.u.) and left/right dorsal end-expiratory lung volume change (a.u.) after prone recruitment and extubation.
The last part of dorsal end-inspiratory volume after extubation was higher after prone (49.1 a.u.; 95% confidence interval [CI], 37.4-60.6) supine recruitment (24.2 a.u.; 95% CI, 18.4-29.6; =0.024). Improvement in left dorsal end-expiratory lung volume after extubation was higher after prone (382 a.u.; 95% CI, 261-502) supine recruitment (-71 a.u., 95% CI, -140 to -2; =15; <0.001). After prone recruitment, left right predominant end-expiratory dorsal lung volume change disappeared after extubation. However, both left and right end-expiratory volumes were higher in the prone group, after extubation.
Recruitment in the prone position improves dorsal inspiratory and end-expiratory lung volumes after cardiac surgery.
NCT03009331.
心脏手术会导致背侧基底段肺不张以及通气/血流不匹配，这与感染和延长的重症监护相关。术后进行肺容积复张操作以降低肺不张程度是常规做法。在严重呼吸衰竭患者中，俯卧位和复张操作可能会提高生存率、改善氧合或两者兼有。我们比较了俯卧位和仰卧位肺复张对背侧吸气期和呼气末期肺通气的影响。
在一项前瞻性随机对照试验中，30例心脏手术后患者被随机分配至俯卧位（n = 15）或仰卧位（n = 15）进行复张操作。主要终点为拔管后晚期背侧吸气容积（任意单位[a.u.]）以及左/右背侧呼气末期肺容积变化（a.u.），采用电阻抗断层扫描在俯卧位和仰卧位拔管后进行测量。次要结局包括俯卧位复张和拔管后左/右背侧吸气容积（a.u.）以及左/右背侧呼气末期肺容积变化（a.u.）。
拔管后背侧吸气末期容积的最后部分在俯卧位复张后更高（49.1 a.u.；95%置信区间[CI]，37.4 - 60.6），而仰卧位复张后为（24.2 a.u.；95% CI，18.4 - 29.6；P = 0.024）。拔管后左背侧呼气末期肺容积的改善在俯卧位复张后更高（382 a.u.；95% CI，261 - 502），而仰卧位复张后为（-71 a.u.，95% CI，-140至-2；P = 0.001）。俯卧位复张后，拔管后左/右优势呼气末期背侧肺容积变化消失。然而，拔管后俯卧位组的左、右呼气末期容积均更高。
俯卧位复张可改善心脏手术后背侧吸气期和呼气末期肺容积。
NCT03009331。
