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Continuous positive airway pressure does not improve lung function after cardiac surgery

[La ventilation en pression positive continue n’améliore pas la fonction pulmonaire après la cardiochirurgie]

Ece Altmay, MD^*, Pelin Karaca, MD^*, Nurgül Yurtseven, MD^*, Vedat Özkul, MD^*, Tamer Aksoy, MD^*, Azmi Özler, MD and Sevim Canik, MD^*

^* From the Department of Anesthesiology and Reanimation, and the
Department of Thoracic and Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Ïstanbul, Turkey.

Address correspondence to: Dr. Pelin Karaca, Postane Mah. Rauf Orbay Cad. Bilginoglu Sitesi, NO: 3 Tuzla / Istanbul, Turkey. Phone: +90-262-6785090; Fax: +90-262-6540055; E-mail: pelus72{at}yahoo.com

Purpose: Despite the well-documented impairment of pulmonary function after cardiopulmonary bypass, effective precautions and ideal management strategies for this problem are still under debate. This study aimed to evaluate the effects of continuous positive airway pressure (CPAP) applied during cardiopulmonary bypass on respiratory and hemodynamic variables.

Methods: In this randomized, prospective, controlled trial, 120 male patients, aged 45 to 70 yr undergoing first-time elective bypass surgery, were randomly assigned to receive either 10 cm H₂O of CPAP (Group I; n = 60) during cardiopulmonary bypass, or serve as control (Group II; n = 60), where the patient’s lungs were vented to atmosphere during the bypass period.

Results: Alveolar-arterial oxygen partial pressure difference and shunt fraction were significantly higher in the control group compared with the CPAP group after cardiopulmonary bypass (T₂ ) and after closure of sternum (T₃ ), (P < 0.05). No differences between groups with respect to hemodynamic variables were observed at any time. Postoperative pulmonary function variables were lower in both groups compared to baseline values.

Conclusions: Continuous positive airway pressure administered during cardiopulmonary bypass decreased shunt fraction and alveolar-arterial oxygen partial pressure difference during surgery, but had no sustained effect on either variable postoperatively. We conclude that, in patients with normal preoperative pulmonary function, application of 10 cm H₂O CPAP does not improve lung function after cardiac surgery.