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J Thorac Cardiovasc Surg 2007;134:1193-1198
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Effect of cardiopulmonary bypass and aortic clamping on functional residual capacity and ventilation distribution in children

^a Pediatric Anesthesia Unit, Geneva Children’s Hospital, Geneva, Switzerland
^b Department of Medical Informatics, University of Szeged, Szeged, Hungary
^c University Children’s Hospital, Basel, Switzerland.

Received for publication November 28, 2006; revisions received March 28, 2007; accepted for publication March 29, 2007.

^_* Address for reprints: Britta von Ungern-Sternberg, MD, Pediatric Anesthesia Unit, Geneva Children’s Hospital, 6, Rue Willy Donzé, CH-1205 Geneva, Switzerland. (Email: britta.reglivonungern{at}hcuge.ch).

Objective: To characterize factors that contribute to lung function impairment after cardiopulmonary bypass, we assessed functional residual capacity and ventilation homogeneity during the perioperative period in children with congenital heart disease who are to undergo surgical repair.

Methods: Functional residual capacity and lung clearance index were measured by using a sulfur hexafluoride washout technique in 24 children (aged 0–10 years). Measurements of functional residual capacity and ventilation distribution were performed after induction of anesthesia, at different stages of the surgical procedure, and up to 90 minutes after skin closure. Anesthesia was standardized, and ventilator settings, including the fraction of inspired oxygen, were kept constant throughout the study period.

Results: Sternotomy and retractor insertion led to a significant increase in functional residual capacity (mean [SD], 24% [14%]), followed by a similar percentage decrease in the resting volume after a significant reduction in pulmonary blood flow during cardiopulmonary bypass with aortic clamping. Although reestablishing pulmonary blood flow increased functional residual capacity (10% [6%]), chest closure led to a decrease in functional residual capacity of 36% (14%) that only slightly improved during the first 90 minutes after surgical intervention. Changes in lung clearance index were affected conversely compared with changes in functional residual capacity at all assessment times.

Conclusions: These results confirmed that chest wall condition and pulmonary circulation affect lung volumes and ventilation homogeneity. Although opening of the chest wall improved alveolar recruitment and ventilation homogeneity, blood flow appeared essential for alveolar stability, presumably by exerting a tethering force caused by the filled capillaries on the alveolar walls and therefore contributing to an increase in resting lung volume.

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				B. S. von Ungern-Sternberg Impact of anaesthesia on lung function in children Eur. Respir. Rev., April 1, 2008; 17(107): 26 - 29. [Full Text] [PDF]