Abstract

SANTOS CERQUERA, RAÚL DARÍO  and  ARIZA CADENA, FREDY. Lung protection strategies in cardiovascular surgery. CES Med. [online]. 2012, vol.26, n.1, pp.85-98. ISSN 0120-8705.

Background: Lung structures are exposed to complex and unusual forces during mechanical ventilation. This phenomena is particularly relevant to induce lung damage due to overdistension, generation of turbulent flows of gases and fluids into the alveolar and peripheral bronchial lumen, induction of ischemia-reperfusion lesion and inmunological activation, which are greatly responsible of the secondary systematic inflammatory response. Methods: A search of available medical literature related to protective mechanical ventilation (PMV) in cardiovascular surgery and major surgery was conducted using different medical databases (PubMed/MEDline, SciELO, Hinari and Cochrane). RCTs, retrospective clinical studies, revision articles, case series, cases and controls studies, and clinical guides were reviewed. Results and conclusions: The optimal way for ventilatory support in cardiovascular and major surgery is object to debate. Experimental evidence suggests that ventilation with low tidal volume, lowers pressure at the end of inspiration, and high pressure at the end of expiration, can reduce lung injury associated to ventilation. It was therefore recommended to use current volumes from 6 to 8 ml/Kg of the ideal weight and was defined by the Acute Respiratory Distress Syndrome Net as "protective pulmonary ventilation". Based on studies carried out, there is no convincing evidence that protective mechanical ventilation (Low VT with PEEP) lowers the release of cytokines, transfusion needs, mechanical ventilation times, improve post-surgery pulmonary function or a decrease in mortality, intensive care or hospital stay compared to the conventional ventilation in cardiovascular or major surgery

Keywords : Cardiac surgery; Thoracic surgery; Protective; mechanical ventilation; Cardiopulmonary bypass; Cytokines; Review.

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