Summary
In a group of 18 male patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, the overall incidence of post-operative atelectasis was 60 per cent. Nearly three-quarters occurred during anaesthesia. After operation there was no difference whether CMV or IMV without PEEP was provided overnight. Atelectasis already present did not improve and further atelectasis occurred.
A role for IMV is not excluded, since it facilitates the use of PEEP. Many factors operate and interact to provoke atelectasis during anaesthesia, which increases post-operative morbidity. Many of these factors are preventible or reversible if their physiological basis is understood.
Optimal post-operative ventilation should be tailored to the needs of the individual patient and demands close co-operation between anaesthetist and surgeon.
Résumé
Ľincidence ďatélectasie post-Opératoire a été de 60 pour cent chez 18 patients ayant subi un pontage aorto-coronarien à coeurouvert. Troisquart de ces complications sont survenues au cours de ľanesthésie. On n’a pas noté de différence en utilisant une ventilation obligatoire intermittente (IMV) sans peep au cours de la première nuit au lieu de la ventilation contrôlée ordinaire. Non seulement ľatélectasie déjà présente à
ľarrivée aux soins intensifs ne s’améliorait pas, mais au contraire il s’en produisait davantage. Ľemploi de la ventilation obligatoire intermittente peut quand même présenter des avantages car elle diminue les effets de la peep sur le débit cardiaque.
De nombreux facteurs contribuent à la production ďatélectasie durant ľanesthésie, ce qui augmente la morbidité post-opératoire. Beaucoup de ceux-ci peuvent être prévenus ou corrigés si leur physiopathologie est comprise. Ľassistance respiratoire post-opératoire devrait être choisie en fonction ďun patient donné, ce qui implique une collaboration étroite entre le chirurgien et ľanesthésiste.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Turnbull, K.W., Miyagishima, R.T., &Gerein, A.N. Pulmonary complications and cardiopulmonary bypass: a clinical study in adults. Can. Anaesth. Soc. J.21: 181 (1974).
Estafanous, F.G. Respiratory care following open-heart surgery. Surg. Clin. N. Amer.55: 5: 1299 (1975).
Campbell, G.S. Respiratory failure in surgical patients. Current Problems in Surgery13: 2: 1 (1976).
Midell, A.I., Skinner, D.B., De Boer, A., &Bermudez, G. A review of pulmonary problems following valve replacement in 100 consecutive patients. Ann. Thor. Surg.18: 219 (1974).
Downs, J.B., Mitchell, L.A., Dannemiller, F.J., &Stanford, W. Modification of airway closure and pulmonary gas exchange following cardiac surgery (abstract). Critical Care Med.3: 41 (1975).
Downs, J.B. &Mitchell, L.A. Pulmonary effects of ventilatory pattern following cardiopulmonary bypass. Critical Care Med.4: 295 (1976).
Margand, P.M.S. &Chodoff, P. IMV: an alternative weaning technic: a case report. Anesth. and Analg.54: 41 (1975).
Downs, J.B., Klein, E.F., Desautels, D., Modell, J.H., &Kirby, R.R. IMV: a new approach to weaning patients from mechanical ventilators. Chest.64: 331 (1973).
Kirby, R.R. A new pediatric volume ventilator. Anesth. and Analg.50: 533 (1971).
Kirby, R.R., Robison, E., Schulz, J., &de Lemos, R.A. Continuous flow ventilation as an alternative to assisted and controlled ventilation in infants. Anesth. and Analg.51: 871 (1972).
Downs, J.B., Perkins, H.M., &Modell, J.H. Intermittent mandatory ventilation: an evaluation. Arch. Surg.109: 519 (1974).
Feeley, T.W. &Hedley-Whyte, J. Current concepts: weaning from controlled ventilation and oxygen. New Eng. J. Med.292: 903 (1975).
Kirby, R.R. Is IMV a satisfactory alternative to assisted and controlled ventilation. Lecture #207b. Annual Refresher Course Lectures. A.S.A. 1 (1975).
Klein, E.F. Weaning from mechanical breathing with IMV. Arch. Surg.110: 345 (1975).
Downs, J.B., Block, A.J., &Vennum, K.B. Intermittent mandatory ventilation in the treatment of patients with chronic obstructive pulmonary disease. Anesth. and Analg.53: 437 (1974).
Kirby, R.R., Perry, J.C., Calderwood, H.W., Ruiz, B.D., &Lederman, D.S. Cardiorespiratory effects of high positive end-expiratory pressure. Anesthesiology43: 533 (1975).
Bryan-Brown, C.W. Guidelines for ventilatory management in patients in heart failure. Abstracts: 14th Symposium on Critical Care Medicine: 21 (1976).
Wilson, R.S. &Pontoppidan, H. Acute respiratory failure: diagnostic and therapeutic criteria. Critical Care Med.2: 293 (1974).
Laver, M.B., Morgan, J., Bendixen, H.H., &Radford, E.P. Lung volume, compliance and arterial oxygen tensions during controlled ventilation. J. Appl. Phys.19: 725 (1964).
Hedley-Whyte, J., Laver, M.B., &Bendixen, H.H. Effect of change in tidal ventilation on physiological shunting. Amer. J. Physiol.206: 891 (1964).
Bartlett, R.H., Krop, P., Hanson, E.L., &Moore, F.D. Physiology of yawning and its application to post-operative care. Surg. Forum21: 222 (1970).
Bartlett, R.H., Gazzaniga, A.B., &Geraghty, T.R. Respiratory manoeuvers to prevent post-operative pulmonary complications. J. Amer. Med. Assoc.224: 1017 (1973).
La Force, F.M., Mullane, J.F., Boehme, R.F., Kelly, W.J., &Huber, G.L. The effect of pulmonary edema on antibacterial defenses of the lung. J. Lab. Clin. Med.82: 634 (1973).
Roth, E., Lax, L.C., &Maloney, J.V. Ringer’s lactate solution and extracellular fluid volume in the surgical patient: a critical analysis. Ann. Surg.169: 149 (1969).
Comroe, J.H. Physiology of Respiration, 2nd ed. Chicago: Year Book (1974).
Lindholm, C., Ollman, B., Snyder, J., Millen, E., &Grenvik, A. Flexible fieroptic bronchoscopy in critical care medicine. Critical Care Med.2: 250 (1974).
Froese, A.B. &Bryan, C.B. Effects of anaesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology41: 242 (1974).
Veith, F.J. &Roeio, A.G. Evaluation of respiratory function in surgical patients; importance of pre-operative preparation and prediction of pulmonary complications. Surgery45: 905 (1959).
Milledge, J.S. Therapeutic fibreoptic bronchoscopy in intensive care. Brit. Med. J.2: 1427 (1976).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sladen, R.N., Jenkins, L.C. Intermittent mandatory ventilation and controlled mechanical ventilation without positive end-expiratory pressure following cardio-pulmonary bypass. Can. Anaesth. Soc. J. 25, 166–172 (1978). https://doi.org/10.1007/BF03004875
Issue Date:
DOI: https://doi.org/10.1007/BF03004875