ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 27-31

A comparative study between positive end expiratory pressure and high peak inspiratory pressure as a lung recruitment strategy during off-pump coronary artery bypass grafting


1 Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt
2 Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
3 Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt

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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJCA.0000429558.80071.a1

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Background

The respiratory function is impaired in off-pump coronary artery bypass (OPCAB). This study was carried out to detect whether a positive end expiratory pressure (PEEP) is essential to improve lung compliance and arterial pressure of oxygen (PaO2) in patients undergoing OPCAB.

Patients and methods

Sixty patients scheduled for undergoing OPCAB were randomized to receive either peak inspiratory pressure (PIP) at 30 cm H2O with PEEP at 10 cm H2O for 1 min, after which PIP was raised to 40 cm H2O together with PEEP at 15 cm H2O for another minute (group P) or PIP at 30 cm H2O for 1 min, followed by PIP at 40 cm H2O for another minute without any PEEP (group NP). Both lung compliance and PaO2 were measured at four time points: T1, after induction of general anesthesia; T2, before raising the PIP and PEEP; T3, 30 min after raising the PIP and PEEP; and T4, at the end of surgery. In the ICU, PaO2 was measured 30 min after admission to ICU (T5), 1 h after raising the PIP to 30 cm H2O (T6), and 4 h later (T7).

Results

As regards pulmonary compliance and intraoperative and postoperative PaO2, there was no statistically significant difference between the two groups. However, the mean arterial pressure after applying PEEP was significantly lower in group P than in group NP, both during surgery and in the ICU (P<0.05).

Conclusion

Both recruitment strategies, PEEP and high PIP, are protective and tolerable in patients undergoing OPCAB.



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