Naslov
Off-pump coronary bypass surgery adversely affects alveolar gas exchange

Autori
Gašparović, Hrvoje ; Unić, Daniel ; Sutlić, Željko ; Husedžinović, Ino ; Biočina, Bojan ; Rudež, Igor ; Nikić, Nada ; Jelić, Ivan

Izvornik
Collegium antropologicum (0350-6134) 32 (2008), 1; 293-298

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
off pump coronary artery bypass ; lung injury ; lactate ; alveolar-arterial oxygen gradient

Sažetak
While the introduction of off-pump myocardial revascularization (OPCAB) has initially shown promise in reducing respiratory complications inherent to conventional coronary surgery, it has failed to eradicate them. Our study focused on quantifying the lactate release from the lungs and the dysfunction at the level of the alveolar-capillary membrane precipitated by OPCAB at different time points after the insult. Furthermore, we aimed to determine the impact of pulmonary lactate production on systemic lactic acid concentrations. The study was conducted in a prospective observational fashion. Forty consecutive patients undergoing OPCAB were analyzed. The mean patient age was 60 +/- 10 years. The mean EUROScore was 3.8 +/- 2.9. The alveolar-arterial O(2) gradient increased from 19 [range 9 to 30] to 26 [range 20 to 34] kPa (P<0.001) and remained elevated up to 6 hours after surgery. It rapidly declined again by 18 hours postoperatively. The observed increase in the pulmonary lactate release (PLR) from a baseline value of 0.022 [range -0.074 to 0.066] to 0.089 [range 0.016 to 0.209] mmol/min/m(2) at six hours postoperatively did not reach statistical significance (P=0.105). The systemic arterial lactate (L(S)) concentration increased from 0.94 [range 0.78 to 1.06] to 1.39 [range 0.97 to 2.81] mmol/L (P < 0.001). The venoarterial pCO(2) difference showed no significant change in comparison to baseline values. The mortality in the studied group was 2.5% (1/40). The pulmonary lactate production showed a statistically significant correlation with the systemic lactate concentration (R=0.46 ; P=0.003). Pulmonary injury following off pump myocardial revascularization was evidenced by a prompt increase in the alveolar-arterial oxygen gradient. The alveolar-arterial 02 gradient correlated with the duration of mechanical ventilation.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA