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Abstract
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Background and Aims Cardiac surgery influences respiratory morbidity through multiple mechanisms. In our institution, the anesthesia team uses classic protective ventilation strategies. Optimization of ventilation could still be possible. The primary endpoint is to evaluate the potential for alveolar recruitment, in patients undergoing cardiac surgery, at 2 times (after intubation, and after cardiopulmonary bypass (CPB), by collecting the values of pulmonary compliance and the R/I ratio. The secondary endpoint is to determine if there are statistically significant differences, in terms of respiratory and hemodynamic parameters between patients with a ratio to patients who are above or below the median.
Methods This is a prospective and observational study. The patients studied are undergoing cardiac surgery. Patients‘ perioperative data were recorded. With a maneuver we calculates the R/I ratio and the recruited volume and the compliance of the recruited lung. The ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio.
Results Intermediate results show significant differences with improvement of compliance 10 min after recruitment. The median R/I was 1.58 +/- 0.67 before CPB and, 1.15 +/- 64 after CPB indicating a potential for recruitment. P/F values did not show a statistically significant increase, which could reflect good pulmonary vasoconstriction in pulmonary atelectasis. Recruitment maneuvers, with moderate PEEP, are well tolerated in our patients.
Results
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Conclusions R/I ratio highlights a potential for recruitment in our cardiac surgery patients. This test is hemodynamically well tolerated and could differentiate patients who are candidates for an increase in PEEP. A larger study is needed to confirm these results.