Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Cardiac surgery can be complicated by pulmonary abnormalities, but it is unclear how various manifestations interrelate.

METHODS: A prospective study in the intensive care unit was performed on 26 mechanically ventilated patients without cardiac failure within 3 h after elective cardiac surgery involving cardiopulmonary bypass. Oedema (extravascular lung water, EVLW) was measured by the thermal-dye technique and permeability by a dual radionuclide technique, yielding a pulmonary leak index (PLI). Radiographic, mechanical and gas exchange features were used to calculate the lung injury score (LIS), ranging between 0 and 4. Evidence for left lower lobe atelectasis was obtained from plain radiographs. The plasma colloid osmotic pressure (COP) was measured by an oncometer.

RESULTS: The EVLW (normal, <7 ml/kg) was elevated in 36% of patients and the PLI (normal, <14.1 x 10(-3)/min) in 44%, but the variables did not interrelate directly. Patients with a supranormal EVLW had a lower COP than patients with normal EVLW. The duration of mechanical ventilation was prolonged in patients (20%) with EVLW > 10 ml/kg. There was no difference in EVLW and PLI in patients with LIS < 1 and LIS > 1 (31% of patients). In patients with radiographic evidence for atelectasis (46%), the positive end-expiratory pressure and inspiratory O2 fraction to maintain oxygenation were higher than in those without.

CONCLUSIONS: After cardiac surgery, mild pulmonary oedema is relatively common, even in the absence of high filling pressures, and is mainly attributable to a low COP, irrespective of increased permeability in about one-half of patients. It may prolong mechanical ventilation at EVLW > 10 ml/kg. However, pulmonary radiographic and ventilatory abnormalities may result, at least in part, from atelectasis rather than increased permeability oedema.

Original languageEnglish
Pages (from-to)1302-1310
Number of pages9
JournalActa Anaesthesiologica Scandinavica
Volume49
Issue number9
DOIs
Publication statusPublished - Oct 2005

Cite this

@article{833a9df26a6947008c3caf465a7ca6dc,
title = "Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema",
abstract = "BACKGROUND: Cardiac surgery can be complicated by pulmonary abnormalities, but it is unclear how various manifestations interrelate.METHODS: A prospective study in the intensive care unit was performed on 26 mechanically ventilated patients without cardiac failure within 3 h after elective cardiac surgery involving cardiopulmonary bypass. Oedema (extravascular lung water, EVLW) was measured by the thermal-dye technique and permeability by a dual radionuclide technique, yielding a pulmonary leak index (PLI). Radiographic, mechanical and gas exchange features were used to calculate the lung injury score (LIS), ranging between 0 and 4. Evidence for left lower lobe atelectasis was obtained from plain radiographs. The plasma colloid osmotic pressure (COP) was measured by an oncometer.RESULTS: The EVLW (normal, <7 ml/kg) was elevated in 36{\%} of patients and the PLI (normal, <14.1 x 10(-3)/min) in 44{\%}, but the variables did not interrelate directly. Patients with a supranormal EVLW had a lower COP than patients with normal EVLW. The duration of mechanical ventilation was prolonged in patients (20{\%}) with EVLW > 10 ml/kg. There was no difference in EVLW and PLI in patients with LIS < 1 and LIS > 1 (31{\%} of patients). In patients with radiographic evidence for atelectasis (46{\%}), the positive end-expiratory pressure and inspiratory O2 fraction to maintain oxygenation were higher than in those without.CONCLUSIONS: After cardiac surgery, mild pulmonary oedema is relatively common, even in the absence of high filling pressures, and is mainly attributable to a low COP, irrespective of increased permeability in about one-half of patients. It may prolong mechanical ventilation at EVLW > 10 ml/kg. However, pulmonary radiographic and ventilatory abnormalities may result, at least in part, from atelectasis rather than increased permeability oedema.",
keywords = "Adult, Aged, Cardiac Surgical Procedures/adverse effects, Cardiopulmonary Bypass, Critical Care, Extravascular Lung Water/physiology, Female, Humans, Lung/diagnostic imaging, Lung Diseases/etiology, Male, Middle Aged, Osmotic Pressure, Permeability, Prospective Studies, Pulmonary Atelectasis/etiology, Pulmonary Edema/etiology, Pulmonary Gas Exchange/physiology, Radiography, Respiratory Function Tests, Capillary Permeability, Capillary Leak Syndrome/diagnosis, Mechanical ventilation, Intensive care unit, Gallium Radioisotopes",
author = "J Verheij and {van Lingen}, A and Raijmakers, {P G H M} and J-J Spijkstra and Girbes, {A R J} and Jansen, {E K} and {van den Berg}, {F G} and Groeneveld, {A B J}",
year = "2005",
month = "10",
doi = "10.1111/j.1399-6576.2005.00831.x",
language = "English",
volume = "49",
pages = "1302--1310",
journal = "Acta An{\ae}sthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Blackwell Munksgaard",
number = "9",

}

Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema. / Verheij, J; van Lingen, A; Raijmakers, P G H M; Spijkstra, J-J; Girbes, A R J; Jansen, E K; van den Berg, F G; Groeneveld, A B J.

In: Acta Anaesthesiologica Scandinavica, Vol. 49, No. 9, 10.2005, p. 1302-1310.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Pulmonary abnormalities after cardiac surgery are better explained by atelectasis than by increased permeability oedema

AU - Verheij, J

AU - van Lingen, A

AU - Raijmakers, P G H M

AU - Spijkstra, J-J

AU - Girbes, A R J

AU - Jansen, E K

AU - van den Berg, F G

AU - Groeneveld, A B J

PY - 2005/10

Y1 - 2005/10

N2 - BACKGROUND: Cardiac surgery can be complicated by pulmonary abnormalities, but it is unclear how various manifestations interrelate.METHODS: A prospective study in the intensive care unit was performed on 26 mechanically ventilated patients without cardiac failure within 3 h after elective cardiac surgery involving cardiopulmonary bypass. Oedema (extravascular lung water, EVLW) was measured by the thermal-dye technique and permeability by a dual radionuclide technique, yielding a pulmonary leak index (PLI). Radiographic, mechanical and gas exchange features were used to calculate the lung injury score (LIS), ranging between 0 and 4. Evidence for left lower lobe atelectasis was obtained from plain radiographs. The plasma colloid osmotic pressure (COP) was measured by an oncometer.RESULTS: The EVLW (normal, <7 ml/kg) was elevated in 36% of patients and the PLI (normal, <14.1 x 10(-3)/min) in 44%, but the variables did not interrelate directly. Patients with a supranormal EVLW had a lower COP than patients with normal EVLW. The duration of mechanical ventilation was prolonged in patients (20%) with EVLW > 10 ml/kg. There was no difference in EVLW and PLI in patients with LIS < 1 and LIS > 1 (31% of patients). In patients with radiographic evidence for atelectasis (46%), the positive end-expiratory pressure and inspiratory O2 fraction to maintain oxygenation were higher than in those without.CONCLUSIONS: After cardiac surgery, mild pulmonary oedema is relatively common, even in the absence of high filling pressures, and is mainly attributable to a low COP, irrespective of increased permeability in about one-half of patients. It may prolong mechanical ventilation at EVLW > 10 ml/kg. However, pulmonary radiographic and ventilatory abnormalities may result, at least in part, from atelectasis rather than increased permeability oedema.

AB - BACKGROUND: Cardiac surgery can be complicated by pulmonary abnormalities, but it is unclear how various manifestations interrelate.METHODS: A prospective study in the intensive care unit was performed on 26 mechanically ventilated patients without cardiac failure within 3 h after elective cardiac surgery involving cardiopulmonary bypass. Oedema (extravascular lung water, EVLW) was measured by the thermal-dye technique and permeability by a dual radionuclide technique, yielding a pulmonary leak index (PLI). Radiographic, mechanical and gas exchange features were used to calculate the lung injury score (LIS), ranging between 0 and 4. Evidence for left lower lobe atelectasis was obtained from plain radiographs. The plasma colloid osmotic pressure (COP) was measured by an oncometer.RESULTS: The EVLW (normal, <7 ml/kg) was elevated in 36% of patients and the PLI (normal, <14.1 x 10(-3)/min) in 44%, but the variables did not interrelate directly. Patients with a supranormal EVLW had a lower COP than patients with normal EVLW. The duration of mechanical ventilation was prolonged in patients (20%) with EVLW > 10 ml/kg. There was no difference in EVLW and PLI in patients with LIS < 1 and LIS > 1 (31% of patients). In patients with radiographic evidence for atelectasis (46%), the positive end-expiratory pressure and inspiratory O2 fraction to maintain oxygenation were higher than in those without.CONCLUSIONS: After cardiac surgery, mild pulmonary oedema is relatively common, even in the absence of high filling pressures, and is mainly attributable to a low COP, irrespective of increased permeability in about one-half of patients. It may prolong mechanical ventilation at EVLW > 10 ml/kg. However, pulmonary radiographic and ventilatory abnormalities may result, at least in part, from atelectasis rather than increased permeability oedema.

KW - Adult

KW - Aged

KW - Cardiac Surgical Procedures/adverse effects

KW - Cardiopulmonary Bypass

KW - Critical Care

KW - Extravascular Lung Water/physiology

KW - Female

KW - Humans

KW - Lung/diagnostic imaging

KW - Lung Diseases/etiology

KW - Male

KW - Middle Aged

KW - Osmotic Pressure

KW - Permeability

KW - Prospective Studies

KW - Pulmonary Atelectasis/etiology

KW - Pulmonary Edema/etiology

KW - Pulmonary Gas Exchange/physiology

KW - Radiography

KW - Respiratory Function Tests

KW - Capillary Permeability

KW - Capillary Leak Syndrome/diagnosis

KW - Mechanical ventilation

KW - Intensive care unit

KW - Gallium Radioisotopes

U2 - 10.1111/j.1399-6576.2005.00831.x

DO - 10.1111/j.1399-6576.2005.00831.x

M3 - Article

VL - 49

SP - 1302

EP - 1310

JO - Acta Anæsthesiologica Scandinavica

JF - Acta Anæsthesiologica Scandinavica

SN - 0001-5172

IS - 9

ER -