Intraoperative Lung Protection in the Surgical Treatment of Patients with Infective Endocarditis Complicated by Respiratory Failure
Saving function of the pulmonary circulation for a period of cardiopulmonary bypass is controversial moment in the anesthetic management protocols of cardiac surgery. The desirable maintaining of blood flow in the pulmonary artery is based on the following facts: baseline pulmonary involvement in all patients with infective endocarditis (IE); supply of the components of lung parenchyma microvasculature is due to oxygen in alveolar air; finding ways to remove activated neutrophils during cardiopulmonary bypass to reduce the severity of lung injury. Objective: to estimate the effectiveness of intraoperative lung protection methods under different anesthetic management protocols in the surgical treatment of patients with IE complicated by respiratory failure. Materials. Analysis of the effectiveness of lung protection methods was performed in 151 patients - standard (n = 80) and new (n = 71) protocols. Modified protocol of intraoperative management of patients with IE differs from the standard one by preserved ventilation (tidal volume 4 ml/kg, FiO2 0.3, respiratory rate 4 per 1 min) and perfusion a.pulmonalis with arterial blood through lateral branch of arterial line without additional pumping device during cardioplegic cardiac arrest. Results. Duration of mechanical ventilation decreased from 18.4 ± 1.9 h to 13.5 ± 1.3 h (p = 0.028). Incidence of postoperative respiratory failure decreased from 6.3 % (2010) to 2.8 % (2012). Conclusions. Introduction of lung protection methods has reduced the incidence of postoperative respiratory failure.