Effects of early vital capacity maneuver on respiratory variables during multivessel off-pump coronary artery bypass graft surgery

Jae Kwang Shim, Duck Hee Chun, Yong Seon Choi, Ji Yeon Lee, Seong Wook Hong, Younglan Kwak

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES:: Despite avoiding cardiopulmonary bypass, similar degrees of pulmonary impairment compared with on-pump coronary artery bypass surgery have been demonstrated in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) compared with on-pump coronary artery bypass surgery. To investigate the effects of an early vital capacity maneuver (VCM) on intrapulmonary shunt (Qs/Qt), oxygenation, and pulmonary outcome in OPCAB. DESIGN:: Prospective, randomized, controlled, double-blind clinical trial. SETTING:: Cardiothoracic operating room and intensive care unit (ICU) of a university hospital. PATIENTS:: Fifty patients scheduled for OPCAB were randomized to treatment with VCM or none. INTERVENTIONS:: After sternotomy, VCM was performed by inflating the lungs to 40 cm H2O and holding this pressure for 10 seconds. MEASUREMENTS AND MAIN RESULTS:: Qs/Qt, Pao2/Fio2 (P/F) ratio, and dynamic and static pulmonary compliances were measured before induction of anesthesia (T0), 15 minutes after tracheal intubation (T1), during Y-graft construction (T2), 15 minutes after completion of grafting (T3), 15 minutes after sternal closure (T4), and 3 hours after arrival at the ICU (T5). Qs/Qt was lower and P/F ratio was higher in the VCM group at T2 through T5. Pulmonary compliances were also higher in the VCM group at T4 and T5. Patients in the VCM group were extubated earlier. CONCLUSIONS:: The beneficial effects of an early VCM on Qs/Qt persisted into the period of ICU care, with an improvement in P/F ratio and preserved pulmonary compliances, leading to a shorter time to extubation.

Original languageEnglish
Pages (from-to)539-544
Number of pages6
JournalCritical Care Medicine
Volume37
Issue number2
DOIs
Publication statusPublished - 2009 Jan 1

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Off-Pump Coronary Artery Bypass
Vital Capacity
Coronary Artery Bypass
Transplants
Lung Compliance
Intensive Care Units
Lung
Sternotomy
Operating Rooms
Cardiopulmonary Bypass
Intubation
Anesthesia
Clinical Trials
Pressure

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Shim, Jae Kwang ; Chun, Duck Hee ; Choi, Yong Seon ; Lee, Ji Yeon ; Hong, Seong Wook ; Kwak, Younglan. / Effects of early vital capacity maneuver on respiratory variables during multivessel off-pump coronary artery bypass graft surgery. In: Critical Care Medicine. 2009 ; Vol. 37, No. 2. pp. 539-544.
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Effects of early vital capacity maneuver on respiratory variables during multivessel off-pump coronary artery bypass graft surgery. / Shim, Jae Kwang; Chun, Duck Hee; Choi, Yong Seon; Lee, Ji Yeon; Hong, Seong Wook; Kwak, Younglan.

In: Critical Care Medicine, Vol. 37, No. 2, 01.01.2009, p. 539-544.

Research output: Contribution to journalArticle

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AB - OBJECTIVES:: Despite avoiding cardiopulmonary bypass, similar degrees of pulmonary impairment compared with on-pump coronary artery bypass surgery have been demonstrated in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) compared with on-pump coronary artery bypass surgery. To investigate the effects of an early vital capacity maneuver (VCM) on intrapulmonary shunt (Qs/Qt), oxygenation, and pulmonary outcome in OPCAB. DESIGN:: Prospective, randomized, controlled, double-blind clinical trial. SETTING:: Cardiothoracic operating room and intensive care unit (ICU) of a university hospital. PATIENTS:: Fifty patients scheduled for OPCAB were randomized to treatment with VCM or none. INTERVENTIONS:: After sternotomy, VCM was performed by inflating the lungs to 40 cm H2O and holding this pressure for 10 seconds. MEASUREMENTS AND MAIN RESULTS:: Qs/Qt, Pao2/Fio2 (P/F) ratio, and dynamic and static pulmonary compliances were measured before induction of anesthesia (T0), 15 minutes after tracheal intubation (T1), during Y-graft construction (T2), 15 minutes after completion of grafting (T3), 15 minutes after sternal closure (T4), and 3 hours after arrival at the ICU (T5). Qs/Qt was lower and P/F ratio was higher in the VCM group at T2 through T5. Pulmonary compliances were also higher in the VCM group at T4 and T5. Patients in the VCM group were extubated earlier. CONCLUSIONS:: The beneficial effects of an early VCM on Qs/Qt persisted into the period of ICU care, with an improvement in P/F ratio and preserved pulmonary compliances, leading to a shorter time to extubation.

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