2022, Number 1
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Revista Cubana de Anestesiología y Reanimación 2022; 21 (1)
Protective ventilation strategies in cardiovascular surgery
Alonso VJA, Falcón GM, Hernández RM, de Arazoza HA, Nodal LP, Saínz CH
Language: Spanish
References: 34
Page: 1-14
PDF size: 318.42 Kb.
ABSTRACT
Introduction: The alteration in gas exchange is a complication of cardiac surgery
with extracorporeal circulation. The cause of this deterioration is multifactorial.
During the shunt, both lungs collapse and at the end of the extracorporeal
circulation the lungs expand again, without a standard technique for it. The
application of alveolar recruitment during general anesthesia in this type of
surgery improves arterial oxygenation. Multiple strategies are used and have as a
reference the extracorporeal circulation and its contribution to the pulmonary
and systemic inflammatory response. This forces the anesthesiologist to
understand the pathophysiology of lung injury associated with mechanical
ventilation.
Objective: Describe essential aspects of pathophysiology of pulmonary injury
associated with mechanical ventilation in cardiac surgical procedures and the
effect of perioperative protective mechanical ventilation as a strategy to prevent
it.
Method: A search of the literature published during the period between January
1990 and December 2020 was carried out that referred to protective mechanical
ventilation strategies in cardiovascular surgery.
Results: Experimental and clinical evidence suggest that low current volumes of
pulmonary ventilation and the application for a short period of increased
inspiratory pressures, known as "recruitment maneuvers" followed by the
application of positive pressure at the end of expiration to keep the recruited
alveoli open, increase functional residual capacity and reduce lung injury
associated with mechanical ventilation. These recommendations have been
extrapolated from retrospective studies conducted in other types of populations.
Conclusions: There is no strong evidence that this strategy decreases the proinflammatory
response, improves postoperative lung function and decreases
perioperative mortality, when compared to conventional ventilation.
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