tailieunhanh - Báo cáo hóa học: " High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages | Tripathi et al. Critical Care 2012 16 405 http content 16 1 405 CRITICAL CARE LETTER L_ High-frequency oscillatory ventilation after cardiac surgery a treatment for all ages Ravi S Tripathi 1 Erica J Stein1 Juan A Crestanello2 and Thomas J Papadimos1 See related research by Bojan etal. http content 15 5 R259 In a recent issue of Critical Care Bojan and colleagues 1 reported their experience with early initiation of high-frequency oscillatory ventilation HFOV in pediatric cardiac surgery that demonstrated shorter mechanical ventilation times and intensive care stays. Acute lung injury is common in adult patients undergoing surgery yet there is scant reporting of the intraoperative utility of HfOV 2 . We initiated HFOV in a 49-year-old morbidly obese body mass index of 69 kg m2 man who had aortic stenosis pulmonary hypertension and decompensated congestive heart failure and who was undergoing aortic valve replacement. Separation from cardiopulmonary bypass CPB with inverse-ratio pressure-control ventilation - fraction of inspired oxygen FiO2 of and positive end-expiratory pressure PEEP of 18 cm H2O -failed because of hypoxia defined as an arterial partial pressure of oxygen PaO2 of 64 mm Hg. HFOV was initiated mean pressure airway of 33 cm H2O and FiO2 of yielding a PaO2 of 74 mm Hg and allowing CPB separation. The patient was transitioned to conventional ventilation on postoperative day 3 and was extubated on postoperative day 5. This adult patient benefited from HFOV as did the pediatric population of Bojan and colleagues. Continuous positive intrathoracic pressure is a concern as it may impede venous return and thereby limit cardiac output CO 3 . However the transition from ventilation with PEEP to HFOV usually results in significant changes in oxygenation ventilation but not in CO 4 . In patients with pulmonary hypertension HFOV has been demonstrated to increase CO and decrease pulmonary vascular resistance 5 . For our .