Effect of PEEP on lung function in children with pulmonary hypertension
- VernacularTitle:PEEP对肺高压患儿呼吸功能的影响
- Author:
Yue HUANG
;
Jiajun MA
;
Ying SUN
;
At ET
- Publication Type:Journal Article
- Keywords:
Positive-pressure respiration;
Hypertension, pulmonary;
Child;
Cardiopulmonary bypass;
Respiratory function tests
- From:
Chinese Journal of Anesthesiology
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of different modes of mechanical ventilation on lung function during open heart surgery in children with pulmonary hypertension (PH). Methods Twenty-four patients with moderate PH aged 3 mon-12 yr 2mon (group M) and twenty-four patients with severe PH aged 3 mon-7yr 9mon (group S) were further divided randomly into 3 subgroups based on the modes of mechanical ventilation used: pressure-controlled ventilation(PCV) only and alveolar pressure (Palveo) was maintained at 0 cm H2O during CPB (group M1/S1 n = 8); PCV + PEEP (2 cm H2O) and Palveo was maintained at 2 cm H2O during CPB (group M2/S2 n = 8); and PCV+ PEEP (4 cm H2O) and Palveo was maintained at 4 cm H2O during CPB (group M3/S3 n=8). The patients were premedicated with atropine 0.01 mg ?kg -1 and midazolam 0. 1 mg?kg-1 . Anesthesia was induced with fentanyl 20?g?kg-1 and vecuronium 0. 1 mg?kg-1 and maintained with vecuronium infusion(70?g?kg-1?h-1 ) and inhalation of N2O-O2 and isoflurane. The children were mechanically ventilated after intubation and the ventilatory parameters were VT = 10-12 ml ?kg-1, F = 20 bpm and I : E = 1: 2. Lungs were lavaged and 2-3 ml of aspirate were taken for determination of surfactant. Total protein (TP), total phospholipid -(TPL), saturated phosphatidylcholine (Sat PC) and respiratory system compliance(Crs) was measured before skin incision( T0 ), before CPB (T,), at the end of CPB ( T2) and at the end of surgery(T3 ) . Results (1) Crs decreased significantly at T2 and T3 as compared with that at T0 and T1 in group M1/S1 and M2/S2 but in group M3/S3 there was no significant difference in Crs between T0, T1 and T2-3. (2) Sat PC/TPL and Sat PC/TP decreased significantly after CPB (T2, T3 ) in group M,/S, and M2/S2 but in group M3/S3 there was no significant difference in Sat PC/TP and Sat PC/TPL between T0-1 and T2-3. Conclusion PEEP 4 cm H2O can effectively prevent postoperative lung function from worsening in children with pulmonary hypertension undergoing open heart surgery with CPB.
