The effects of a lung recruitment manoeuvre before extubation on pulmonary function after coronary artery bypass surgery

[摘要] ENGLISH ABSTRACT: Aim: The aim of this study is to determine if the addition of a pre-extubation recruitmentmanoeuvre to standard care is safe and will improve lung compliance and subsequentPaO2/FiO2 (PF ratio) after extubation in postoperative coronary artery bypass graft surgerypatients.Design: Prospective, triple blind, randomised, controlled trial.Method: This study was conducted in a private hospital in the Northern suburbs of CapeTown, South Africa. All patients admitted between 03/10/2010 and 22/11/2011, foruncomplicated elective coronary artery bypass graft (CABG) surgery were eligible forinclusion into the study. Patients were randomly allocated into either the intervention groupor the control group. The intervention group received a gradual build-up lung recruitmentmanoeuvre (RM). The primary outcome was PaO2/FiO2 (PF ratio). The secondary outcomeswere safety and static lung compliance. ICU length of stay (LOS) and hospital LOS werealso recorded. The pre-RM hemodynamic stability of the patient was checked before theintervention and repeated at 5 minutes after the intervention by the nursing sister. Data tocalculate static lung compliance was captured at the same time. Criteria for safety anddiscontinuation of the RM were monitored during the intervention by the principle investigatoronly.Results: Of the 69 patients eligible for the study 47 were randomly allocated into theintervention group (n=22) and control group (n=25) respectively. Groups were the same atbaseline with regards to sex, pulmonary risk, sedation and surgical procedures. The RMcould be completed in all patients. The prior defined criteria for discontinuation of the RMwere not reached in any of the patients. No adverse effects were noted. The PaO2/FiO2 (PFratio) decreased significantly in both groups from pre-surgery measurements compared towhen measured before the RM (p<0.001). There was a tendency noted for the interventiongroup to return to pre-surgery measurements of PF ratio within 12 hours after extubationwhen compared to the control group. There was no significant difference between thegroups from extubation to 24 hours (p = 0.6). The static compliance improved at 5 minutesfollowing the RM (p<0.001) and remained improved until extubation (p<0.001) for theintervention group. No difference was noted in the static compliance of the control groupover the same time period. The mean hospital length of stay for the intervention group was8.61 (95% confidence interval 7.26 to 9.96 days) and 10.08 (95% confidence interval 8.52 –11.63 days) for the control group.Conclusion: A gradual recruitment manoeuvre at 30cmH2O 30minutes before extubationsignificantly improved static lung compliance within 5 minutes with no adverse hemodynamicside effects. There was noted maintained improved PF ratio at extubation or immediatelyafterwards for the intervention group and no difference in the PF ratio between theintervention group and control group.

[发布机构] Stellenbosch University