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The effect of high-frequency ventilation of the lungs on postbypass oxygenation: A comparison with other ventilation
Deeb Zabeeda1, Revaz Gefen, Beniamin Medalion
1Department of Anesthesia, Wolfson Medical Center, Holon, Affiliated with Sackler School of Medicine, Tel Aviv, Israel.
Objective:
To compare the effect of high-frequency ventilation versus other ventilation methods applied during cardiopulmonary bypass on postbypass oxygenation.
Design:
Prospective, randomized study.
Setting:
University hospital.
Participants:
Seventy-five patients undergoing coronary artery bypass graft surgery.
Interventions:
Patients were allocated to 5 equal groups of different ventilation methods during bypass. Groups 1 and 2 received high-frequency, low-volume ventilation with 100% and 21% oxygen, respectively. Groups 3 and 4 received 5 cm H(2)O of continuous positive airway pressure (CPAP) with either 100% or 21% oxygen. Patients from group 5 were disconnected from the ventilator during the bypass period.
Measurements And Main Results:
Spirometry data, blood gas analysis, oxygen saturation as measured by pulse oximetry, and end-tidal carbon dioxide were recorded 5 minutes before chest opening, 5 minutes before bypass, 5 minutes after bypass, 5 minutes after chest closure and 6, 12, 18, and 24 hours after surgery. There were no differences in compliance and mean airway pressures. Alveolar-to-arterial oxygen gradients increased, and PaO(2) decreased significantly (p < 0.05) in all groups 5 minutes after bypass and this trend continued in the postoperative period. Patients from group 3 had higher PaO(2) and lower alveolar-to-arterial oxygen gradients, 5 minutes after weaning from bypass (p < 0.05). Extubation times were similar in all groups.
Conclusions:
The alveolar-arterial oxygen gradient was lower, and the PaO(2) was higher 5 minutes after bypass in patients receiving CPAP (100% O(2)) as compared with those ventilated with high-frequency ventilation.
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