Airway Pressure Release Ventilation Improves Pulmonary Blood Flow And Cardiac Output Following Cardiac Surgery For Congenital Heart Disease
Circulation(2009)
摘要
Introduction: Airway Pressure Release Ventilation (APRV) maintains a constant airway pressure (P aw ) with brief intermittent pressure reductions and permits spontaneous respiration without triggering the ventilator. Elevated P aw can critically reduce pulmonary blood flow (Q P ). We hypothesized that spontaneous ventilatory effort transmitted to the pleural space during APRV would result in a transient decrease in intrapleural pressure and increase Q P follow surgery for Tetralogy of Fallot or cavopulmonary connection (Glenn, Fontan). Methods: After obtaining IRB approval and patient consent, we studied children immediately following surgery. Q P and cardiac output (CO) were compared with APRV and positive pressure ventilation, with/without spontaneous ventilation. APRV was compared with positive pressure ventilation in the absence and presence of spontaneous respiratory effort in 4 × 30-minute phases. Oxygen consumption (VO 2 ) was measured (mass spectrometer), and Q P and CO calculated (Fick equation). Constant levels of PaCO 2 and mean P aw were targeted in all study phases. Results: Nineteen patients were enrolled in the study, 9 following repair of tetralogy of Fallot and 10 following a Glenn/Fontan operation. In the absence of spontaneous ventilation, there were no differences in Q P or any of the measured gas exchange or hemodynamic parameters. In the presence of spontaneous ventilation, there were significant differences in the measured parameters (Table). Conclusion: Ventilation with APRV (at comparable mean P aw ) improves Q P , and other gas exchange/hemodynamic variables compared with positive pressure ventilation in children following cardiac surgery. Although this study focused on tetralogy of Fallot repair and Glenn/Fontan operations, the improved cardiopulmonary interactions may be beneficial in other situations where hemodynamics are adversely modified by positive pressure ventilation.
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