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Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass
Rodrigues, R. R; Sawada, A. Y; Rouby, J. -J; Fukuda, M. J; Neves, F. H; Carmona, M. J; Pelosi, P; Auler, J. O; Malbouisson, L. M. S.
  • Rodrigues, R. R; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Sawada, A. Y; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Rouby, J. -J; University Pierre and Marie Curie. La Pitié Salpetrière Hospital. Department of Anesthesiology and Critical Care and Medicine. Multidisciplinary Intensive Care Unit. Paris. FR
  • Fukuda, M. J; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Neves, F. H; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Carmona, M. J; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Pelosi, P; Universita’ degli Studi dell’ Insubria. Dipartimento Ambiente, Salute e Sicurezza. Insubria. IT
  • Auler, J. O; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
  • Malbouisson, L. M. S; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Divisão de Anestesia. São Paulo. BR
Braz. j. med. biol. res ; 44(6): 598-605, June 2011. ilus, tab
Artículo en Inglés | LILACS | ID: lil-589972
ABSTRACT
Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 ± 9 years. The PaO2/FiO2 ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31 percent postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19 percent (P < 0.001). Non-aerated lung increased by 253 ± 97 g (P < 0.001), from 3 to 27 percent, after surgery and poorly aerated lung by 72 ± 68 g (P < 0.001), from 24 to 27 percent, while normally aerated lung was reduced by 147 ± 119 g (P < 0.001), from 72 to 46 percent. No correlations (Pearson) were observed between PaO2/FiO2 ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone.
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Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Apnea / Puente Cardiopulmonar / Procedimientos Quirúrgicos Cardíacos / Pulmón Tipo de estudio: Estudio de etiología Límite: Anciano / Aged80 / Femenino / Humanos / Masculino Idioma: Inglés Revista: Braz. j. med. biol. res Asunto de la revista: Biologia / Medicina Año: 2011 Tipo del documento: Artículo País de afiliación: Brasil / Francia / Italia Institución/País de afiliación: Universidade de São Paulo/BR / Universita&#8217; degli Studi dell&#8217; Insubria/IT / University Pierre and Marie Curie/FR

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Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Apnea / Puente Cardiopulmonar / Procedimientos Quirúrgicos Cardíacos / Pulmón Tipo de estudio: Estudio de etiología Límite: Anciano / Aged80 / Femenino / Humanos / Masculino Idioma: Inglés Revista: Braz. j. med. biol. res Asunto de la revista: Biologia / Medicina Año: 2011 Tipo del documento: Artículo País de afiliación: Brasil / Francia / Italia Institución/País de afiliación: Universidade de São Paulo/BR / Universita&#8217; degli Studi dell&#8217; Insubria/IT / University Pierre and Marie Curie/FR