ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of positive end expiratory pressure on right ventricular functions in coronary artery bypass graft surgery
Melis Türker1, Aynur Camkıran Fırat1, Bahar Pirat2, Atilla Sezgin3, Arash Pirat1
1Başkent Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, Türkiye
2Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
3Başkent Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye
DOI : 10.5606/tgkdc.dergisi.2017.13267
Background: This study aims to investigate the effect of positive endexpiratory pressure on the right ventricular functions by speckle tracking method in patients undergoing coronary artery bypass grafting. Methods: This prospective study included a total of 20 patients (17 males, 3 females; mean age 59.7±10.5 years; range 42 to 77 years) who underwent coronary artery bypass grafting between May 2013 and September 2013. After initiation of 5 cmH2O positive end-expiratory pressure during mechanical ventilation before sternotomy, 10 and 20 cmH2O of positive end-expiratory pressure were applied in five-min intervals, respectively. Four-chamber and two-chamber views of the right ventricle were recorded at each pressure level using transesophageal echocardiography. The right ventricle diameter and velocity, longitudinal strain and strain rate, and right ventricle fractional area change were calculated. Results: Intraoperative systolic, diastolic, and mean blood pressures and mean heart rate were similar at the three positive end-expiratory pressure levels. The mean right ventricle strain value was significantly lower at 20 cmH2O pressure (p<0.001 for both). The mean strain rate was significantly lower at 20 cmH2O pressure, compared to 5 cmH2O pressure (p=0.03). The right ventricle velocity was found to significantly decreased with increasing positive end-expiratory pressure (p<0.05). The mean right ventricle fractional area change was similar at 5 and 10 cmH2O pressures (p=0.063), while it was significantly lower at 20 cmH2O pressure (p=0.001). The mean right ventricle diameter decreased with increasing positive end-expiratory pressure, while this decrease was significant at 20 cmH2O pressure (p=0.01). Conclusion: Our study results show that 5, 10, and 20 cmH2O positive end-expiratory pressures does not significantly change hemodynamic data in patients undergoing coronary artery bypass grafting with normal right ventricular functions; however, 20 cmH2O positive end-expiratory pressure leads to decreased right ventricular functions, as assessed by transesophageal echocardiography.
Keywords : Coronary artery bypass grafting; positive end-expiratory pressure; right ventricular function; speckle tracking echocardiography
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