Pulmonary Dysfunction After Cardiac Surgery

• Published in: Chest Vol. 121; no. 4; pp. 1269 - 1277
• Main Authors: Ng, Calvin S.H., Wan, Song, Yim, Anthony P.C., Arifi, Ahmed A.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.04.2002; American College of Chest Physicians; Elsevier B.V
• Subjects: Biological and medical sciences; cardiac surgery; Cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Causes of; Collagen; Complications and side effects; Coronary Artery Bypass; Coronary vessels; cytokine; Edema; Enzymes; Heart surgery; Hospital Mortality; Humans; inflammatory response; ischemia-reperfusion; Lung - blood supply; Lung diseases; lung injury; Medical sciences; Microscopy; Neutrophils; Nitric oxide; Permeability; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Proteins; Pulmonary arteries; Reperfusion Injury - diagnosis; Reperfusion Injury - mortality; Reperfusion Injury - physiopathology; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - mortality; Respiratory Insufficiency - physiopathology; Risk Factors; Surfactants; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Veins & arteries; ventilation; Hong Kong; cytokine; NO; VCM; CPAP; IL; P(A-a)O2; ventilation; inflammatory response; LT; ischemia-reperfusion; TNF; PMN; MMP; PA; TXB2; lung injury; CPB; cardiopulmonary bypass; cardiac surgery; CABG; neutrophils; Heart; Human; Postoperative; Pathophysiology; Lung; Cardiovascular disease; Cardiopulmonary bypass; Lung function; Reperfusion; Treatment; Ischemia; Heart disease; Surgery; Complication
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.121.4.1269

Postoperative lung injury is one of the most frequent complications of cardiac surgery that impacts significantly on health-care expenditures and largely has been believed to result from the use of cardiopulmonary bypass (CPB). However, recent comparative studies between conventional and off-pump coronary artery bypass grafting have indicated that CPB itself may not be the major contributor to the development of postoperative pulmonary dysfunction. In our study, we review the associated physiologic, biochemical, and histologic changes, with particular reference to the current understanding of underlying mechanisms. Intraoperative modifications aiming at limiting lung injury are discussed. The potential benefits of maintaining ventilation and pulmonary artery perfusion during CPB warrant further investigation.