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Normothermic perfusion and lung function after cardiopulmonary bypass: effects in pulmonary risk patients

M Ranucci

Department of Cardiac Anaesthesia, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

G Soro

Department of Cardiac Anaesthesia, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

A Frigiola

Department of Cardiac Surgery, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

L Menicanti

Department of Cardiac Surgery, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

A Ditta

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

G Candido

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

S Tambalo

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

Fifty patients at risk for postoperative lung dysfunction and undergoing elective coronary revascularization have been randomly assigned to receive normothermic (36°C) perfusion with warm heart protection (NP group) or hypothermic (28°C) perfusion with cold heart protection (HP group).

Lung function before and after cardiopulmonary bypass (CPB) was studied through the determination of the intrapulmonary shunt (Qs/Qt), the alveolo-arterial oxygen gradient (A-a{Delta}O2), and the artero-alveolar carbon dioxide gradient (a-A{Delta}CO2). The Q s /Q t after CPB was significantly lower in the NP group (27.1 ± 2.6 vs 35.7 ± 2.3) as well as the A-a{Delta}O2 (50.2 ± 1.5 vs 57.6 ±2.4); both data returned to comparable between the groups after 3 h in the intensive care unit. The a-A{Delta}CO2 was significantly lower after CPB in the NP group (5.2 ± 0.74 vs 8.2 ± 0.8). Hospital stay and mortality were comparable in the two groups; intubation time and rate of early extubation showed a trend in favour of the NP group; the rate of patients suffering hypoxia and/or hypercapnia after extubation was significantly lower in the NP group (12%) versus the HP group (44%).

Normothermia seems to exert a protective effect against lung dysfunction after CPB. The absence of a rewarming injury associated with reperfusion, a limitation of the hypothermic-induced vasoconstriction due to local cooling of the lung and a better compliance of the normothermic lung are hypothesized as beneficial effects of the ‘all-warm’ strategy.

Perfusion, Vol. 12, No. 5, 309-315 (1997)
DOI: 10.1177/026765919701200506
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