Araştırma Makalesi
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Cardiopulmonary Bypass and Perioperative Mechanical Ventilation Strategy: National Turkey Study

Yıl 2024, Cilt: 19 Sayı: 2, 5 - 14, 22.07.2024
https://doi.org/10.17517/ksutfd.1277664

Öz

Objective: This study aims to describe anesthesiologists' perioperative mechanical ventilation strategies in cases where cardiopulmonary bypass (CPB) is performed in Turkey.

Material and Methods: Survey questions were sent twice via e-mail to members of the two associations consisting of specialists in Anesthesiology and Reanimation. The questions were divided into three parts to determine anesthesia applications and mechanical ventilation strategies in the preoperative, intraoperative, and postoperative periods of CPB.

Results: The questionnaire was provided with the participation of 269 anesthesiologists. 105 (40.2%) participants stated that the number of intensive care unit beds in their hospital was over 20. A 6 ml/kg (42.5%) coefficient is preferred in calculating tidal volume outside the CPB process. The number of participants who preferred low (0-5 cmH2O) positive end-expiratory pressure (PEEP) throughout the surgery was 41.1%. 40.8% of the participants prefer 5-10 cmH2O PEEP in “hemodynamically stable and obese patients”. During the CPB process, 38.3% of the participants turned off the mechanical ventilator, and 24.4 % preferred to wean the patient from the mechanical ventilator. While 35.8 % of anesthesia specialists preferred recruitment maneuvers, 38.9% did not. It was concluded that 51% of the participants preferred non-invasive ventilation in patients with hypoxemia/hypercapnia, and 55.1% applied pulmonary rehabilitation after extubation to all patients.

Conclusion: Our study showed that the mechanical ventilation strategies followed by most anesthesiologists in CPB in Turkey are similar.

Kaynakça

  • Fischer MO, Brotons F, Briant AR, Suehiro K, Gozdzik W, Sponholz C, et al. Postoperative Pulmonary Complications After Cardiac Surgery: The VENICE International Cohort Study. J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt A):2344-2351.
  • Lagier D, Velly LJ, Guinard B, Bruder N, Guidon C, Vidal Melo MF, et al. Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery. Anesthesiology. 2020;133(5):1029-1045.
  • Arcêncio L, Souza MDD, Bortolin BS, Fernandes ACM, Rodrigues AJ, Evora PRB. Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach. Brazilian Journal of Cardiovascular Surgery, 2008;23:400-410.
  • White A, Patvardhan C, Falter F. Anesthesia for minimally invasive cardiac surgery. J Thorac Dis. 2021;13(3):1886-1898.
  • Weisberg AD, Weisberg EL, Wilson JM, Collard CD. Preoperative evaluation and preparation of the patient for cardiac surgery. Medical Clinics of North America, 2009 Sep;93(5):979-94.
  • Ellis JE, Tung A, Lee H, Lee H, Kasza K. Anesthesiologists' preferences for preoperative cardiac evaluation before vascular surgery: results of a mail survey. J Clin Anesth. 2010;22(6):402-409.
  • Wang YC, Huang CH, Tu YK. Effects of Positive Airway Pressure and Mechanical Ventilation of the Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2018;32(2):748-759.
  • Nguyen LS, Estagnasie P, Merzoug M, Brusset A, Law Koune JD, Aubert S, et al. Low Tidal Volume Mechanical Ventilation Against No Ventilation During Cardiopulmonary Bypass in Heart Surgery (MECANO): A Randomized Controlled Trial. Chest. 2021;159(5):1843-1853.
  • Lagier D, Fischer F, Fornier W, Fellahi JL, Colson P, Cholley B, et al. A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial. Trials. 2018;19(1):624.
  • Bignami E, Guarnieri M, Saglietti F, Belletti A, Trumello C, Giambuzzi I, et al. Mechanical Ventilation During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2016;30(6):1668-1675.
  • Lellouche F, Delorme M, Bussières J, Ouattara A. Perioperative ventilatory strategies in cardiac surgery. Best Pract Res Clin Anaesthesiol. 2015;29(3):381-95.
  • Krebs ED, Hawkins RB, Mehaffey JH, Fonner CE, Speir AM, Quader MA, et al. Is routine extubation overnight safe in cardiac surgery patients?. The Journal of thoracic and cardiovascular surgery, 2019;157(4):1533-1542.e2.
  • Martin S, Jackson K, Anton J, Tolpin DA. Pro: Early Extubation (<1 Hour) After Cardiac Surgery Is a Useful, Safe, and Cost-Effective Method in Select Patient Populations. J Cardiothorac Vasc Anesth. 2022;36(5):1487-1490.
  • Wu Q, Xiang G, Song J, Xie L, Wu X, Hao S, et al. Effects of non-invasive ventilation in subjects undergoing cardiac surgery on length of hospital stay and cardiac-pulmonary complications: A systematic review and meta-analysis. J Thorac Dis. 2020;12:1507–1519.
  • Olper L, Bignami E, Di Prima AL, Albini S, Nascimbene S, Cabrini L, et al. Continuous positive airway pressure versus oxygen therapy in the cardiac surgical ward: A randomized trial. J Cardiothorac Vasc Anesth. 2017;31:115–121.

Kardiyopulmoner Baypas ve Perioperatif Mekanik Ventilasyon Stratejisi: Ulusal Türkiye Çalışması

Yıl 2024, Cilt: 19 Sayı: 2, 5 - 14, 22.07.2024
https://doi.org/10.17517/ksutfd.1277664

Öz

Amaç: Bu çalışma, kardiyopulmoner baypas (KPB) uygulanan durumlarda Türkiye'deki anestezi uzmanlarının perioperatif mekanik ventilasyon stratejilerini tanımlamayı amaçlamaktadır.
Gereç ve Yöntemler: Anesteziyoloji ve Reanimasyon uzmanlarından oluşan iki derneğin üyelerine e-posta yoluyla iki kez anket soruları gönderildi. Sorular, KPB cerrahisinde preoperatif, intraoperatif ve postoperatif dönemlerde anestezi uygulamaları ve mekanik ventilasyon stratejilerini belirlemek için üç bölüme ayrılmıştır.
Bulgular: Ankete 269 anestezi uzmanı katıldı. Katılımcıların 105'i (%40.2) hastanelerindeki yoğun bakım ünitesi yatak sayısının 20’nin üzerinde olduğunu belirtti. KPB süreci dışında tidal volüm hesaplanmasında 6 ml/kg (%42.5) katsayısının kullanımı tercih edilmektedir. Ameliyat boyunca düşük (0-5 cmH2O) pozitif ekspiryum sonu basıncı (PEEP) tercih eden katılımcı sayısı %41.1 idi. Katılımcıların %40.8'i “hemodinamik olarak stabil ve obez hastalarda” 5-10 cmH2O PEEP tercih etmektedir. KPB sürecinde katılımcıların %38.3’ü mekanik ventilatörü kapatmaktadır, %24.4’ü hastayı mekanik ventilatörden ayırmayı tercih etmektedir. Anestezi uzmanlarının %35.8’i rekruitment manevralarını tercih ederken, %38.9’u tercih etmemiştir. Katılımcıların %51’inin hipoksemi/hiperkapnisi olan hastalarda non-invaziv ventilasyonu tercih ettiği ve %55.1’inin tüm hastalara ekstübasyon sonrası pulmoner rehabilitasyon uyguladığı sonucuna varıldı.
Sonuç: Çalışmamız, Türkiye’de KPB cerrahisinde çoğu anestezi uzmanının izlediği mekanik ventilasyon stratejilerinin benzer olduğunu göstermiştir.

Kaynakça

  • Fischer MO, Brotons F, Briant AR, Suehiro K, Gozdzik W, Sponholz C, et al. Postoperative Pulmonary Complications After Cardiac Surgery: The VENICE International Cohort Study. J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt A):2344-2351.
  • Lagier D, Velly LJ, Guinard B, Bruder N, Guidon C, Vidal Melo MF, et al. Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery. Anesthesiology. 2020;133(5):1029-1045.
  • Arcêncio L, Souza MDD, Bortolin BS, Fernandes ACM, Rodrigues AJ, Evora PRB. Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach. Brazilian Journal of Cardiovascular Surgery, 2008;23:400-410.
  • White A, Patvardhan C, Falter F. Anesthesia for minimally invasive cardiac surgery. J Thorac Dis. 2021;13(3):1886-1898.
  • Weisberg AD, Weisberg EL, Wilson JM, Collard CD. Preoperative evaluation and preparation of the patient for cardiac surgery. Medical Clinics of North America, 2009 Sep;93(5):979-94.
  • Ellis JE, Tung A, Lee H, Lee H, Kasza K. Anesthesiologists' preferences for preoperative cardiac evaluation before vascular surgery: results of a mail survey. J Clin Anesth. 2010;22(6):402-409.
  • Wang YC, Huang CH, Tu YK. Effects of Positive Airway Pressure and Mechanical Ventilation of the Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2018;32(2):748-759.
  • Nguyen LS, Estagnasie P, Merzoug M, Brusset A, Law Koune JD, Aubert S, et al. Low Tidal Volume Mechanical Ventilation Against No Ventilation During Cardiopulmonary Bypass in Heart Surgery (MECANO): A Randomized Controlled Trial. Chest. 2021;159(5):1843-1853.
  • Lagier D, Fischer F, Fornier W, Fellahi JL, Colson P, Cholley B, et al. A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial. Trials. 2018;19(1):624.
  • Bignami E, Guarnieri M, Saglietti F, Belletti A, Trumello C, Giambuzzi I, et al. Mechanical Ventilation During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2016;30(6):1668-1675.
  • Lellouche F, Delorme M, Bussières J, Ouattara A. Perioperative ventilatory strategies in cardiac surgery. Best Pract Res Clin Anaesthesiol. 2015;29(3):381-95.
  • Krebs ED, Hawkins RB, Mehaffey JH, Fonner CE, Speir AM, Quader MA, et al. Is routine extubation overnight safe in cardiac surgery patients?. The Journal of thoracic and cardiovascular surgery, 2019;157(4):1533-1542.e2.
  • Martin S, Jackson K, Anton J, Tolpin DA. Pro: Early Extubation (<1 Hour) After Cardiac Surgery Is a Useful, Safe, and Cost-Effective Method in Select Patient Populations. J Cardiothorac Vasc Anesth. 2022;36(5):1487-1490.
  • Wu Q, Xiang G, Song J, Xie L, Wu X, Hao S, et al. Effects of non-invasive ventilation in subjects undergoing cardiac surgery on length of hospital stay and cardiac-pulmonary complications: A systematic review and meta-analysis. J Thorac Dis. 2020;12:1507–1519.
  • Olper L, Bignami E, Di Prima AL, Albini S, Nascimbene S, Cabrini L, et al. Continuous positive airway pressure versus oxygen therapy in the cardiac surgical ward: A randomized trial. J Cardiothorac Vasc Anesth. 2017;31:115–121.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Yavuz Orak 0000-0002-8356-6223

Feyza Çalışır 0000-0002-8882-4666

Hafize Öksüz 0000-0001-5963-6861

Türkan Kudsioglu 0000-0003-4109-3170

Ömer Faruk Boran 0000-0002-0262-9385

İlker Solmaz 0000-0002-1959-8159

Adem Doğaner 0000-0002-0270-9350

Erken Görünüm Tarihi 11 Temmuz 2024
Yayımlanma Tarihi 22 Temmuz 2024
Gönderilme Tarihi 5 Nisan 2023
Kabul Tarihi 29 Eylül 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 19 Sayı: 2

Kaynak Göster

AMA Orak Y, Çalışır F, Öksüz H, Kudsioglu T, Boran ÖF, Solmaz İ, Doğaner A. Cardiopulmonary Bypass and Perioperative Mechanical Ventilation Strategy: National Turkey Study. KSÜ Tıp Fak Der. Temmuz 2024;19(2):5-14. doi:10.17517/ksutfd.1277664