Cardiac Surgery
Conditions
Keywords
Lung recruitment maneuver, Fluid responsiveness, cardiac surgery, right cardiac dysfunction, passive leg raising, Transcardiopulmonary Thermodilution, Calibrated Arterial Waveform Analysis, echocardiography
Brief summary
The aim of the study was to assess the ability a Lung Recruitment Maneuver (LRM) with a stepwise increase of PEEP to predict fluid responsiveness and right cardiac dysfunction in mechanically ventilated patients in open heart cardiac surgery. During different phases, all patients received a Passive Leg Raising (PLR) maneuver for preload status evaluation using the PICCO system, a Lung Recruitment Maneuver (LRM) and an echographic evaluation of the right cardiac function. 20 patients were analyzed. Incomplete Lung Recruitment Maneuver (LRM) can predict fluid responsiveness at phase 1, pre-operatively, with a sensitivity of 0.57 and specificity of 0.62. Performance of an incomplete Magnetic Resonance Angiography (MRA) to predict right cardiac dysfunction based on TAPSE post-operatively provides a sensitivity and specificity of respectively 0.33 and 0.17 Tolerance to a stepwise lung recruitment maneuver can not be used to evaluate reliably the preload responsiveness and guide fluid therapy except pre-operatively. The use of a lung recruitment maneuver can be a promising method for right cardiac dysfunction screening but further studies need to be done with different echographic tools for right cardiac dysfunction evaluation.
Interventions
OTHERpassive leg raising maneuver (PLR)
Passive leg raising maneuver (PLR) for preload status evaluation using the PICCO system will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).
OTHERlung recruitment maneuver (LRM)
lung recruitment maneuver (LRM) will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).
OTHERechographic evaluation of the right cardiac function
echographic evaluation of the right cardiac function will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).
Sponsors
Centre Hospitalier Universitaire de Saint Etienne
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients receiving an elective or urgent cardiac surgery with or without extracorporeal circulation under general anesthesia, under protective mechanical ventilation, monitored by invasive arterial blood pressure and pulse contour analysis (PICCO system) for cardiac output measurement and central venous pressure
Exclusion criteria
* Left ventricular ejection fraction ≤ 30% * heart arrhythmia, pulmonary hypertension (SPAP \> 35 mmHg) * right heart failure (TAPSE \< 16 mm, S' at lateral tricuspid valve \< 10 cm/sec) * lower limbs obstructive arteriopathy (stage IIb, III and IV) * severe and very severe chronic obstructive pulmonary disease (COPD) * pneumothorax and extreme weights (BMI \< 35 kg/m2).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fluid responsiveness measured with PiCCO system during Lung recruitment maneuver. | Months: 4 | Measured by PICCO results (phase: 1, 2, 3). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Analysis Right cardiac function - Transthoracic echocardiography | Months: 4 | measured with Transthoracic echocardiography (phase 1, 3). |
| Analysis Right cardiac function - transoesophageal echocardiography | Months: 4 | measured with transoesophageal echocardiography (phase 1, 2). |
Countries
France
Outcome results
None listed