The open lung concept: effects on right ventricular afterload after cardiac surgery

British Journal of Anaesthesia
Dinis Reis MirandaB Lachmann

Abstract

The open lung concept (OLC) is a method of ventilation intended to maintain end-expiratory lung volume by increased airway pressure. Since this could increase right ventricular afterload, we studied the effect of this method on right ventricular afterload in patients after cardiac surgery. We studied 24 stable patients after coronary artery surgery and/or valve surgery with cardiopulmonary bypass. Patients were randomly assigned to OLC or conventional mechanical ventilation (CMV). In the OLC group, recruitment manoeuvres were applied until Pa(o(2))/FI(O(2)) was greater than 50 kPa (reflecting an open lung). This value was maintained by sufficient positive airway pressure. In the CMV group, volume-controlled ventilation was used with a PEEP of 5 cm H(2)O. Cardiac index, right ventricular preload, contractility and afterload were measured with a pulmonary artery thermodilution catheter during the 3-h observation period. Blood gases were monitored continuously. To achieve Pa(O(2))/Fl(O(2)) > 50 kPa, 5.3 (3) (mean, SD) recruitment attempts were performed with a peak pressure of 45.5 (2) cm H(2)O. To keep the lung open, PEEP of 17.0 (3) cm H(2)O was required. Compared with baseline, pulmonary vascular resistance and right ventricula...Continue Reading

Citations

Mar 15, 2006·Current Opinion in Anaesthesiology·Göran Hedenstierna, Arne Tenling
Oct 11, 2005·Critical Care Medicine·Dinis Reis MirandaDiederik Gommers
Aug 26, 2006·Critical Care Medicine·Dinis Reis MirandaDiederik Gommers
Sep 20, 2006·Critical Care Medicine·Martin Dworschak
Jul 17, 2013·European Journal of Anaesthesiology·Javier García-FernándezGöran Hedenstierna
Jun 13, 2006·Critical Care : the Official Journal of the Critical Care Forum·Dinis Reis MirandaDiederik Gommers
Jul 9, 2010·Best Practice & Research. Clinical Anaesthesiology·Gerardo Tusman, Stephan H Böhm
Mar 21, 2007·Critical Care Clinics·Jack J Haitsma
Mar 21, 2007·Critical Care Clinics·Jayashree K Raikhelkar
Jan 24, 2007·Journal of Cardiac Surgery·Lennart KlompeAd J J C Bogers
Jun 22, 2010·Cardiovascular Therapeutics·Gan Hui-li
Dec 19, 2015·BioMed Research International·András Lovas, Tamás Szakmány
Apr 10, 2007·Journal of Cardiothoracic and Vascular Anesthesia·Dinis Reis MirandaBurkhard Lachmann
Jan 22, 2015·Journal of Cardiothoracic and Vascular Anesthesia·Johannes F H UbbenJan U Schreiber
Feb 24, 2015·Critical Care Research and Practice·Rafael BadenesF Javier Belda
Nov 20, 2016·European Journal of Anaesthesiology·Silvina LongoGerardo Tusman
Apr 17, 2021·Critical Care Research and Practice·Vadim MazurokRyta Rzheutskaya

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