Cardiopulmonary Bypass and Perioperative Mechanical Ventilation Strategy: National Turkey Study

Year 2024, Volume: 19 Issue: 2, 5 - 14, 22.07.2024

Yavuz Orak , Feyza Çalışır , Hafize Öksüz , Türkan Kudsioglu , Ömer Faruk Boran , İlker Solmaz , Adem Doğaner

https://doi.org/10.17517/ksutfd.1277664

Abstract

Objective: This study aims to describe anesthesiologists' perioperative mechanical ventilation strategies in cases where cardiopulmonary bypass (CPB) is performed in Turkey.

Material and Methods: Survey questions were sent twice via e-mail to members of the two associations consisting of specialists in Anesthesiology and Reanimation. The questions were divided into three parts to determine anesthesia applications and mechanical ventilation strategies in the preoperative, intraoperative, and postoperative periods of CPB.

Results: The questionnaire was provided with the participation of 269 anesthesiologists. 105 (40.2%) participants stated that the number of intensive care unit beds in their hospital was over 20. A 6 ml/kg (42.5%) coefficient is preferred in calculating tidal volume outside the CPB process. The number of participants who preferred low (0-5 cmH2O) positive end-expiratory pressure (PEEP) throughout the surgery was 41.1%. 40.8% of the participants prefer 5-10 cmH2O PEEP in “hemodynamically stable and obese patients”. During the CPB process, 38.3% of the participants turned off the mechanical ventilator, and 24.4 % preferred to wean the patient from the mechanical ventilator. While 35.8 % of anesthesia specialists preferred recruitment maneuvers, 38.9% did not. It was concluded that 51% of the participants preferred non-invasive ventilation in patients with hypoxemia/hypercapnia, and 55.1% applied pulmonary rehabilitation after extubation to all patients.

Conclusion: Our study showed that the mechanical ventilation strategies followed by most anesthesiologists in CPB in Turkey are similar.

Keywords

Anesthesiologists, Cardiopulmonary Bypass, Cardiac Surgery, Guidelines, Mechanical Ventilation.

Kardiyopulmoner Baypas ve Perioperatif Mekanik Ventilasyon Stratejisi: Ulusal Türkiye Çalışması

Abstract

Amaç: Bu çalışma, kardiyopulmoner baypas (KPB) uygulanan durumlarda Türkiye'deki anestezi uzmanlarının perioperatif mekanik ventilasyon stratejilerini tanımlamayı amaçlamaktadır.
Gereç ve Yöntemler: Anesteziyoloji ve Reanimasyon uzmanlarından oluşan iki derneğin üyelerine e-posta yoluyla iki kez anket soruları gönderildi. Sorular, KPB cerrahisinde preoperatif, intraoperatif ve postoperatif dönemlerde anestezi uygulamaları ve mekanik ventilasyon stratejilerini belirlemek için üç bölüme ayrılmıştır.
Bulgular: Ankete 269 anestezi uzmanı katıldı. Katılımcıların 105'i (%40.2) hastanelerindeki yoğun bakım ünitesi yatak sayısının 20’nin üzerinde olduğunu belirtti. KPB süreci dışında tidal volüm hesaplanmasında 6 ml/kg (%42.5) katsayısının kullanımı tercih edilmektedir. Ameliyat boyunca düşük (0-5 cmH2O) pozitif ekspiryum sonu basıncı (PEEP) tercih eden katılımcı sayısı %41.1 idi. Katılımcıların %40.8'i “hemodinamik olarak stabil ve obez hastalarda” 5-10 cmH2O PEEP tercih etmektedir. KPB sürecinde katılımcıların %38.3’ü mekanik ventilatörü kapatmaktadır, %24.4’ü hastayı mekanik ventilatörden ayırmayı tercih etmektedir. Anestezi uzmanlarının %35.8’i rekruitment manevralarını tercih ederken, %38.9’u tercih etmemiştir. Katılımcıların %51’inin hipoksemi/hiperkapnisi olan hastalarda non-invaziv ventilasyonu tercih ettiği ve %55.1’inin tüm hastalara ekstübasyon sonrası pulmoner rehabilitasyon uyguladığı sonucuna varıldı.
Sonuç: Çalışmamız, Türkiye’de KPB cerrahisinde çoğu anestezi uzmanının izlediği mekanik ventilasyon stratejilerinin benzer olduğunu göstermiştir.

Keywords

Anestezi uzmanları, Kardiyopulmoner Baypas, Kardiyak Cerrahi, Kılavuzlar, Mekanik Ventilasyon.

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