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CRITICAL CARE AND TRAUMA

The Pulmonary and Hemodynamic Effects of Two Different Recruitment Maneuvers After Cardiac Surgery

Serdar Celebi, MD^*, Özge Köner, MD, Ferdi Menda, MD^*, Kubilay Korkut, MD, Kaya Suzer, MD, and Nahit Cakar, MD

From the Departments of *Anesthesiology and Intensive Care, Cardiovascular Surgery, Istanbul University Cardiology Institute; Department of Anesthesiology and Intensive Care, Yeditepe University Hospital; and Department of Anesthesiology and Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

Address correspondence and reprint requests to Özge Köner, Gedikli sok. Vehbi Aytan ap., 31/3 34724, Kiziltoprak, Istanbul, Turkey. Address e-mail to ozgekoner{at}superonline.com.

BACKGROUND: The aim of our study was to evaluate the pulmonary and hemodynamic effects of two different recruitment maneuvers after open heart surgery.

METHODS: Sixty patients undergoing coronary artery bypass surgery were randomized into three groups after operation: recruitment maneuver with continuous positive airway pressure (CPAP) (CPAP-40 group, n = 20), recruitment by positive end-expiratory pressure (PEEP) (PEEP-20 group, n = 20), and 5 cm H₂O PEEP (PEEP-5 group, n = 20). In the CPAP-40 group, 40 cm H₂O peak inspiratory pressure was applied for 30 s, then PEEP was reduced to 20 cm H₂O and ventilation was continued with baseline variables with PEEP decreased until the best Pao₂ was achieved. In the PEEP-20 group, 20 cm H₂O PEEP was set for 2 min, tidal volume was adjusted to achieve a peak inspiratory airway pressure of 40 cm H₂O during the maneuver, then PEEP was decreased until the best Pao₂ had been achieved. In the PEEP-5 group, 5 cm H₂O PEEP was applied postoperatively.

RESULTS: The mean arterial blood pressure of the CPAP-40 group was lower than that of the PEEP-20 (P < 0.01) and PEEP-5 groups (P < 0.01) during the interventions. Oxygenation was higher in both recruitment groups than in the PEEP-5 group during the mechanical ventilation period. There was no significant difference among the groups beyond that period. The atelectasis score of the PEEP-5 group (1.3 ± 0.9) on postoperative day 1 was higher than that of the CPAP-40 (0.65 ± 0.6; P = 0.01) and PEEP-20 (0.65 ± 0.5; P = 0.01) groups.

CONCLUSIONS: The recruitment techniques with postmaneuver PEEP increased oxygenation and decreased atelectasis equally, whereas PEEP-20 provided more stable hemodynamic conditions than the CPAP maneuver.

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