Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Year 2021, Volume: 7 Issue: 1, 59 - 64, 05.01.2021

Tülay Çardaközü , Can Aksu , Ali Ahmet Arıkan

https://doi.org/10.30934/kusbed.794055

Abstract

Amaç: Koroner arter baypas greftleme operasyonunda düşük tidal hacim stratejisi ile akciğer koruyucu ventilasyonda 6ml/kg ile 8 ml/kg tidal hacim sonuçlarını karşılaştırması amaçlanmıştır.
Yöntem: Randomize, tek merkezli, prospektif çalışmaya alınan ardışık 32 hasta, iki eşit gruba ayrıldı. 6ml/kg ve 8ml/kg tidal volüm ile ventilasyonun sonuçları karşılaştırıldı. Arterial kan basınçları, kalp hızı, santral venöz basınç, ekspirasyon tidal hacimi, solunum frekansı, alveolar dakika ventilasyonu, inspirasyon süresi, statik kompliyans, pik hava yolu basıncı, plato basıncı, sürüm basıncı, arter kan gazı verileri ve PaCO2-EtCO2 farkı T1 (CPB'den 15 dak. önce), T2 (kardiyopulmoner baypasın sonlandırılmasından 15 dak. sonra) ve T3 (ameliyatın sonunda) zamanlarında kaydedildi. PaO2/FiO2 oranı ekstübasyon sonrası T1, T2 ve T3 ile 6. (T4) ve 12. saatte (T5) kaydedildi.
Bulgular: Grup 6 ml/kg'da ekstübasyon süresi ve yoğun bakımda kalış süresi anlamlı olarak daha uzundu (sırasıyla p<0,001, p=0,001). Taburculuk süreleri her iki grupta benzerdi. Grup 6ml/kg'da PaCO2 daha yüksekti (sırasıyla T1, T2, T3; p=0,002, p=0,004, p=0,001). Hemodinamik değişiklikler her iki grupta da benzer seyretti. PaO2 / FiO2 oranı Grup 8 ml/kg'da T2'de anlamlı olarak daha yüksek (p=0,009) ve diğer zamanlarda benzerdi.
Sonuç: 8 ml/kg düşük tidal hacim stratejisi ile mekanik ventilasyon, 6 ml/kg ile karşılaştırıldığında daha kısa ekstübasyon süresi ve yoğun bakımda kalış süresi dikkate alındığında daha olumlu sonuçlara sahiptir.

Keywords

Açık kalp cerrahisi, Kardiyak Anestezi, Düşük Tidal Volum Ventilasyon

Low Tidal Volume Ventilation in Open Heart Surgery: Which Tidal Volume is Better 8 ml/kg or 6 ml/kg?

Abstract

Objective: To compare the outcomes of 6m/kg vs. 8 ml/kg tidal volume in the lung protective ventilation - low tidal volume strategy in coronary artery bypass grafting operation.
Methods: Thirty-two patients enrolled in a randomized, single-center, prospective study were divided into two groups. The outcomes of 6m/kg vs. 8 ml/kg were compared. Arterial blood pressures, heart rate, central venous pressure, expired tidal volume, respiratory frequency, the alveolar minute ventilation, the inspiratory time, static compliance, peak airway pressure, plateau pressure, driving pressure, arterial blood gas data and PaCO2-EtCO2 difference were recorded at T1 (15 min. prior to CPB), T2 (15 min. following the termination of cardio pulmonary bypass), and T3 times (at the end of the surgery). PaO2/FiO2 ratio was recorded at T1, T2 and T3 and 6th (T4) and 12th hours (T5) after extubation.
Results: In Group 6ml/kg, extubation time and length of stay in the intensive care unit were significantly longer (p<0.001, p=0.001, respectively). Discharge times were similar in both groups. In group 6ml/kg, PaCO2 was high at all times (T1, T2, T3; p=0.002, p=0.004, p=0.001, respectively), Hemodynamic changes had a similar course in both groups, in Group 6ml/kg. The PaO2/FiO2 ratio was significantly higher in Group 8ml/kg at T2 (p=0.009) and similar at other times.
Conclusion: Mechanical ventilation with a low tidal volume strategy with 8 ml/kg has more favorable outcomes by considering the shorter extubation time and length of stay in the intensive care unit comparing with 6 ml/kg.

Keywords

Open heart surgery, cardiac anesthesia, low tidal volume ventilation

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