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Effect of static lung expansion on pulmonary function following cardiopulmonary bypass in children
Yu Huang1,2, Guolin Lu1,2, Zengchun Wang1,2
1Fujian Children's Hospital, Fujian Branch of Shanghai Children's Medical Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350014, China.
Insights
Static lung expansion during cardiopulmonary bypass improves oxygenation and lung function in children undergoing ventricular septal defect repair. This lung-protective strategy enhances pulmonary outcomes post-cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Respiratory Physiology
- Critical Care Medicine
Background:
- Pediatric cardiac surgery, particularly ventricular septal defect (VSD) repair, often leads to post-operative lung injury.
- Cardiopulmonary bypass (CPB) can exacerbate pulmonary dysfunction, affecting oxygenation and gas exchange.
- Lung-protective ventilation strategies are crucial for mitigating these adverse effects.
Purpose of the Study:
- To evaluate the impact of a lung-protective ventilation strategy, specifically static lung expansion with positive airway pressure, during CPB on pulmonary function in pediatric patients.
- To compare the effects of static lung expansion versus routine ventilation cessation on oxygenation and respiratory indices post-cardiac surgery.
- To assess the efficacy of maintaining lung expansion during CPB in preventing post-operative lung injury.
Main Methods:
- A randomized controlled trial involving 48 pediatric patients (aged 1-3 years) undergoing their first CPB cardiac surgery for VSD.
- Patients were divided into an experimental group (n=30) receiving static lung expansion (5 cmH2O positive airway pressure) during CPB and a control group (n=18) with routine ventilation cessation.
- Pulmonary function, including arterial oxygen partial pressure, respiratory index, and oxygenation index, were measured post-surgery.
Main Results:
- Static lung expansion with 5 cmH2O positive airway pressure during CPB significantly increased arterial oxygen partial pressure in VSD children.
- The experimental group demonstrated a decreased respiratory index and an increased oxygenation index compared to the control group.
- These findings indicate improved pulmonary oxygenation and function following static lung expansion during CPB.
Conclusions:
- Static lung expansion with a continuous positive airway pressure of 5 cmH2O is an effective lung-protective strategy during CPB in pediatric VSD repair.
- This strategy improves post-operative pulmonary oxygenation and function compared to simply terminating mechanical ventilation.
- Implementing static lung expansion during CPB can mitigate lung injury and enhance recovery in children undergoing cardiac surgery.
Objective:
To observe the effect of the lung-protective ventilation strategy, static lung expansion, during cardiopulmonary bypass (CPB) on pulmonary function and tracheal intubation time following cardiac surgery in children.
Methods:
A total of 48 child patients (aged 1-3) with ventricular septal defect (VSD) were enrolled, and all underwent CPB cardiac surgery for the first time. The patients were divided into two groups using the random number table method: the experimental group (Group A, n = 30) and the control group (Group B, n = 18). After terminating the mechanical ventilation during CPB, the adjustable pressure limiting valve of the anesthesia machine was adjusted in the experimental group to maintain the pressure of the breathing circuit at 5 cmH2O, such that both lungs remained in a static expansion state. In the control group, routine mechanical ventilation was terminated as usual.
Results:
When static lung expansion with a continuous positive airway pressure of 5 cmH2O was employed in the VSD children during CPB, compared with termination of mechanical ventilation, the partial pressure of oxygen in the arterial blood increased, while the respiratory index decreased and the oxygenation index increased following the surgery.
Conclusion:
In child patients undergoing VSD reparation under CPB, lung injury occurs following the procedure, and the pulmonary oxygenation function and pulmonary oxygen diffusion function decrease. When static lung expansion of 5 cmH2O is performed during CPB, the improvement in lung function is better than that of apnea without lung expansion pressure.
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