Abstract
Objective
To assess the impact of the lung recruitment maneuver on circulation following cardiac surgery.
Design and setting
Prospective randomized cross-over study at the Departments of Anesthesia and Thoracic Surgery, Copenhagen University Hospital.
Patients
Ten adult undergoing coronary artery bypass surgery.
Interventions
Patients were randomized to two durations of lung recruitment maneuvers (40 cmH2O airway pressure for 10 s and 20 s or vice versa after 5 min) administered immediately after surgery.
Measurements and results
Transesophageal echocardiography (left ventricular short axis view), pulse contour cardiac output, and arterial blood pressure were monitored continuously. Systemic and pulmonary arterial blood gases were sampled before and after each lung recruitment maneuver to calculate the intrapulmonary shunt. Left ventricular end-diastolic areas decreased significantly during both the 10-s and the 20-s lung recruitment maneuvers. Cardiac output was 5.6±0.8 l/min at baseline, decreasing by 3.0±1.1 l/min and 3.6±1.2 l/min during lung recruitment maneuvers of 10 and 20 s, respectively. Shunt decreased from 20±5% to 15±6% after the first lung recruitment maneuver and from 15±6% to 12±5% after the second.
Conclusions
Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.
Similar content being viewed by others
References
Gale GD, Teasdale SJ, Sanders DE, Bradwell PJ, Russell A, Solaric B, York JE (1979) Pulmonary atelectasis and other respiratory complications after cardiopulmonary bypass and investigation of aetiological factors. Can Anaesth Soc J 26:15–21
Magnusson L, Zemgulis V, Wicky S, Tyden H, Thelin S, Hedenstierna G (1997) Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: an experimental study. Anesthesiology 87:1153–1163
Hachenberg T, Tenling A, Nystrom SO, Tyden H, Hedenstierna G (1994) Ventilation-perfusion inequality in patients undergoing cardiac surgery. Anesthesiology 80:509–519
Dyhr T, Laursen N, Larsson A (2002) Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery. Acta Anaesthesiol Scand 46:717–725
Dyhr T, Nygard E, Laursen N, Larsson A (2004) Both lung recruitment maneuver and PEEP are needed to increase oxygenation and lung volume after cardiac surgery. Acta Anaesthesiol Scand 48:187–197
Nunes S, Rothen HU, Brander L, Takala J, Jakob SM (2004) Changes in splanchnic circulation during an alveolar recruitment maneuver in healthy porcine lungs. Anesth Analg 98:1432–1438
Lim SC, Adams AB, Simonson DA, Dries DJ, Broccard AF, Hotchkiss JR, Marini JJ (2004) Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury. Crit Care Med 32:2378–2384
Odenstedt H, Aneman A, Karason S, Stenqvist O, Lundin S (2005) Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI. Intensive Care Med 31:112–120
Rothen HU, Neumann P, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G (1999) Dynamics of re-expansion of atelectasis during general anaesthesia. Br J Anaesth 82:551–556
Fujino Y, Goddon S, Dolhnikoff M, Hess D, Amato MB, Kacmarek RM (2001) Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome. Crit Care Med 29:1579–1586
Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF (1985) An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 5:918–927
Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18:319–321
Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795
Pinsky MR (1997) The hemodynamic consequences of mechanical ventilation: an evolving story. Intensive Care Med 23:493–503
Berg PC van den, Grimbergen CA, Spaan JA, Pinsky MR (1997) Positive pressure inspiration differentially affects right and left ventricular outputs in postoperative cardiac surgery patients. J Crit Care 12:56–65
Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 42:45–55
Dhainaut JF, Devaux JY, Monsallier JF, Brunet F, Villemant D, Huyghebaert MF (1986) Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS. Chest 90:74–80
Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L, Slutsky AS, Ranieri VM (2002) Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 96:795–802
Lapinsky SE, Aubin M, Mehta S, Boiteau P, Slutsky AS (1999) Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 25:1297–1301
Godje O, Hoke K, Goetz AE, Felbinger TW, Reuter DA, Reichart B, Friedl R, Hannekum A, Pfeiffer UJ (2002 Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med 30:52–58
Pinsky MR (2003) Probing the limits of arterial pulse contour analysis to predict preload responsiveness. Anesth Analg 96:1245–1247
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I:307–310
Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol 37:7–11
Whittenberger JL, McGregor M, Berglund E, Borst HG (1960) Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol 15:878–882
Brinker JA, Weiss JL, Lappe DL, Rabson JL, Summer WR, Permutt S, Weisfeldt ML (1980) Leftward septal displacement during right ventricular loading in man. Circulation 61:626–633
Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387–392
Jardin F, Delorme G, Hardy A, Auvert B, Beauchet A, Bourdarias JP (1990) Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 72:966–970
Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650
Versprille A, Jansen JR (1985) Mean systemic filling pressure as a characteristic pressure for venous return. Pflugers Arch 405:226–233
Vieillard-Baron A, Jardin F (2003) Why protect the right ventricle in patients with acute respiratory distress syndrome? Curr Opin Crit Care 9:15–21
Buda AJ, Pinsky MR, Ingels NB Jr, Daughters GT, Stinson EB, Alderman EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301:453–459
Campagna JA, Carter C (2003) Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 98:1250–1260
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is discussed by the editorial available at: http://dx.doi.org/10.1007/s00134-005-2733-y
Supported by the Danish Medical Research Council (no. 22-03-0299 and no. 22-04-0420) and the Danish Heart Foundation (no. 04-10-B152-A230-22194).
Rights and permissions
About this article
Cite this article
Nielsen, J., Østergaard, M., Kjaergaard, J. et al. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med 31, 1189–1194 (2005). https://doi.org/10.1007/s00134-005-2732-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-005-2732-z