[USE OF PROTECTIVE LUNG VENTILATION REGIMEN IN CARDIAC SURGERY PATIENTS.]

Area of Science:

• Cardiology
• Pulmonology
• Anesthesiology

Background:

• Cardiac surgery patients are at risk of lung injury from cardiopulmonary bypass (CPB) and mechanical ventilation.
• Protective lung ventilation (PLV) and preventive bronchoscopy (PB) are strategies to mitigate these risks.

Purpose of the Study:

• To define lung complication risks in cardiac surgery.
• To evaluate the impact of PLV on lung function.
• To assess the feasibility of PB in high pulmonary risk (PR) patients.

Main Methods:

• A prospective randomized study of 66 patients, stratified by PR and ventilation type.
• PLV involved specific ventilator settings (e.g., PIP, Vt, PEEP) and alveolar recruitment.
• Patients underwent measurements of dynamic compliance, p/f ratio, and intrapulmonary shunt (Qs/Qt).

Main Results:

• Group A (high PR + PLV) showed improved dynamic compliance, p/f ratio, and lower Qs/Qt compared to Group B (high PR + conventional LV).
• Group C (low PR + PLV) demonstrated a lower Qs/Qt than Group D (low PR + conventional LV).
• Mucus obstruction affected 53.3% of high PR patients; those without PB had significantly more postoperative lung complications.

Conclusions:

• A protocol for assigning patients to PR groups was effective.
• PLV enhances lung biomechanics and oxygenation in high-PR patients and reduces shunt fraction in both high- and low-PR patients.
• Preventive bronchoscopy is a feasible and beneficial adjunct for high-PR patients.