Fast-track pulmonary conditioning before urgent cardiac surgery in patients with insufficiently treated chronic obstructive pulmonary disease.

AIM: Chronic obstructive pulmonary disease (COPD) is an important risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Despite high clinical relevance, current guidelines lack clear recommendations on the optimal approach for patients with insufficiently treated COPD and urgent need for cardiac surgery. The aim of the present study was to analyze the efficacy of short-term pulmonary conditioning (PC) in this subset of cardiopulmonary patients. METHODS: Eighteen patients with urgent need for cardiac surgery were treated with 1 mg budenoside twice a day, 1.25 mg salbutamol four times a day and 15 mg ambroxol three times a day. On average, patients received pulmonary conditioning for 5.1 ± 2.1 days. Lung function was assessed before and after treatment. RESULTS: Pulmonary conditioning improved forced expiratory volume in one second (FEV1) by 16% (P<0.001). Predicted FEV1 increased from 48.3 ± 13.6% at baseline to 55.4 ± 16.1% after treatment (P<0.001). Total resistance was reduced from 0.933 ± 0.418 kPa·s/L to 0.631 ± 0.344 kPa·s/L after PC (P=0.004). The percentage of patients in GOLD stages III-IV was reduced from 55.6% at baseline to 27.8% after treatment. After surgery, patients needed mechanical ventilation for 2 ± 3.4 days. One patient (5.6%) received a tracheostomy and four patients (22.2%) developed pneumonia; 30-day mortality was 5.6%. CONCLUSION: Short-term treatment with budenoside, salbutamol and ambroxol significantly improved lung function parameters. If surgery can be delayed for several days, pulmonary conditioning should be considered for patients with insufficiently treated COPD.

[Ballon dilatational tracheostomy. Technique and first clinical experience with the Ciaglia Blue Dolphin method]. / Tracheotomie mittels Ballondilatation. Technik und erste klinische Erfahrungen mit der Ciaglia-Blue-Dolphin-Methode.

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) has become an established therapy for patients with prolonged intubation. It is of utmost importance for respiratory weaning of long-term ventilated patients in modern intensive care medicine. One attempt to bring PDT to perfection is a balloon dilatation technique that exerts mainly radial force to widen the tracheostoma. PATIENTS AND METHODS: Twenty patients from a cardiosurgical intensive care unit underwent PDT with the new system. We analyzed the results based on the practical feasibility and possible complications from this balloon dilatation. RESULTS: Tracheostomy surgery lasted on average 3.3+/-1.9 min. It caused no bleeding requiring treatment nor injuries to the posterior tracheal wall. One fracture of a single tracheal cartilage ring was revealed, and one patient developed subcutaneous emphysema during the balloon dilatation. No wound infection was observed. CONCLUSION: Balloon dilatational tracheostomy proved to be feasible, easy, and safe in the hands of experienced users. Its mainly radial force may reduce typical complications such as fracture of tracheal cartilage rings or injuries to the posterior tracheal wall.