Alveolar recruitment manoeuvre is safe in children prone to pulmonary hypertensive crises following open heart surgery: a pilot study

作者：Amorim Erica de Freitas; Guimaraes Viviane Assuncao; Carmona Fabio; de Carvalho Panzeri Carlotti Ana Paula; Manso Paulo Henrique; Ferreira Cesar Augusto; Klamt Jyrson Guilherme; de Andrade Vicente Walter Villela

来源：Interactive Cardiovascular and Thoracic Surgery, 2014, 18(5): 602-606.

DOI：10.1093/icvts/ivt484

• Open heart surgery
• Congenital heart disease
• Pulmonary arterial hypertension
• Alveolar recruitment manoeuvre
• Pulmonary hypertensive crises

OBJECTIVES: To test the tolerance and safety of an alveolar recruitment manoeuvre performed in the immediate postoperative period of corrective open heart surgery in children with congenital heart disease associated with excessive pulmonary blood flow and pulmonary arterial hypertension due to left-to-right shunt.
METHODS: Ten infants aged 1-24 months with congenital heart disease associated with excessive pulmonary blood flow and pulmonary artery hypertension (mean pulmonary artery pressure >= 25 mmHg) were evaluated. The alveolar recruitment manoeuvre was performed in the operating theatre right after skin closure, and consisted of three successive stages of 30 s each, intercalated by a 1-min interval of baseline ventilation. Positive end-expiratory pressure was set to 10 cmH(2)O in the first stage and to 15 cmH(2)O in the two last ones, while the peak inspiratory pressure was kept at to 30 cmH(2)O in the first stage and at 35 cmH(2)O in the latter ones. Haemodynamic and respiratory variables were recorded.
RESULTS: There was a slight but significant increase in mean pulmonary artery pressure from baseline to Stage 3 (P = 0.0009), as well as between Stages 1 and 2 (P = 0.0001), and 1 and 3 (P = 0.001), with no significant difference between Stages 2 and 3 (P = 0.06). Upon completion of the third stage, there were significant increases in arterial haemoglobin saturation as measured by pulse oximetry (P = 0.0009), arterial blood partial pressure of oxygen (P = 0.04), venous blood oxygen saturation of haemoglobin (P = 0.03) and arterial oxygen partial pressure over inspired oxygen fraction ratio (P = 0.04). A significant reduction in arterial blood partial pressure of carbon dioxide (P = 0.01) and in end tidal carbon dioxide also occurred (P = 0.009). The manoeuvre was well tolerated and besides a slight and transitory elevation in mean pulmonary artery, no other adverse haemodynamic or ventilatory effect was elicited.
CONCLUSIONS: The alveolar recruitment manoeuvre seemed to be safe and well tolerated immediately after open heart surgery in infants liable to pulmonary hypertensive crises.

• 出版日期2014-5