Объемная капнография как способ оценки эффективности альвеолярной вентиляции в клинической практике

The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV (p<0.01). VA was also higher during PSV (p<0.05). The calculated VD/VT ratio differed between PCV and PSV mode (p<0.01).Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation.Цель исследования — сравнить взаимосвязь между объемом мертвого пространства и дыхательным объемом (VD/VT) методом объемной капнографии (VCap) в режимах искусственной вентиляции легких с управляемым давлением (PCV) и поддержкой давлением (PSV) в послеоперационном периоде.Материалы и методы. В обсервационное, проспективное исследование методом случайного выбора включили 30 пациентов из отделения сердечно-сосудистой хирургии, перенесших операцию аортокоронарного шунтирования (АКШ) с экстракорпоральным кровообращением. Пациентов подключали к системе вентиляции легких сразу при поступлении в отделение интенсивной терапии. Затем проводили мониторинг VD/VT, продукции CO2 (VECO2), а также параметров вентиляции. Параметры вентиляции в режимах с управляемым давлением (PCV) и поддержкой давлением (PSV) статистически оценивалиРезультаты. Не выявили достоверных различий концентрации CO2 во выдыхаемом воздухе (ETCO2) между режимами PCV и PSV (p=NS), хотя как VECO2, так и минутная вентиляция (MV) возрастали в режиме PSV (p<0,01). Отношение VD/VT в режиме PSV было ниже, чем в режиме PCV. Газообмен, представленный альвеолярной вентиляцией (VA), был лучше в режиме PSV (p<0,01). Показатель VA был также выше в режиме PSV (p<0,05). Расчетное отношение VD/VT различалось между режимами PCV и PSV (p<0,01).Заключение. Объемная капнография (VCap) является средством мониторинга эффективности обмена CO2. Отмечали снижение VD/VT с улучшением альвеолярной вентиляции (VA) в режиме PSV. VCap представляется подходящим методом регулирования протективной вентиляции легких

Surgical treatment of aortic coarctation

Coarctation of the aorta accounts for about 8% of all congenital heart diseases. Since the first successful case of surgical treatment in 1944 by Crafoord and Nylin1 in Sweden, several surgical techniques have been employed in the treatment of this anomaly. Here, we review by illustration the various surgical options in coarctation of the aorta with emphasis on our preferred technique – the extended resection and end-to-end anastomosis. Why the extended resection technique? Our experience - and that of other institutions - has shown that this is a better option in childhood as it is associated with a lesser degree of recoarctation and subsequent need for re-intervention.

Volumetric Сapnography As a Tool for Evaluation of Alveolar Ventilation Effectiveness in Clinical Practice

The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV (p<0.01). VA was also higher during PSV (p<0.05). The calculated VD/VT ratio differed between PCV and PSV mode (p<0.01).Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation