Ádám L Balogh, Roberta Südy, József Tolnai, Gergely H Fodor, Ferenc Peták, Barna Babik
{"title":"心脏手术中胸壁对呼吸力学、通气和通气灌注匹配的影响。","authors":"Ádám L Balogh, Roberta Südy, József Tolnai, Gergely H Fodor, Ferenc Peták, Barna Babik","doi":"10.1053/j.jvca.2025.08.039","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate how sternotomy and subsequent sternal closure affect respiratory mechanics, ventilation heterogeneity, ventilation-perfusion (V/Q) matching, and oxygenation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Design: </strong>Prospective consecutive self-controlled clinical investigation.</p><p><strong>Setting: </strong>A university hospital.</p><p><strong>Participants: </strong>53 patients undergoing elective cardiac surgery.</p><p><strong>Interventions: </strong>Measurements performed at 4 protocol stages: before sternotomy, immediately after sternotomy, after weaning from CPB, and after sternal closure.</p><p><strong>Measurements and main results: </strong>Respiratory mechanics (airway resistance, tissue damping, and elastance) were assessed using forced oscillations, and ventilation heterogeneity was evaluated via capnographic slopes (phase 2 and phase 3). Physiologic dead spaces (Bohr and Enghoff fractions), V/Q matching, and oxygenation (partial pressure of oxygen [PaO<sub>2</sub>]/fraction of inspired oxygen [FiO<sub>2</sub>] ratio, intrapulmonary shunt fraction) were analyzed as well. Sternotomy significantly improved airway resistance (-30%), tissue damping (-25%), and elastance (-35%), thereby enhancing ventilation homogeneity (phase 3 slope reduced by 20%; p < 0.001). Conversely, CPB markedly deteriorated respiratory mechanics and ventilation efficiency (airway resistance, +45%; elastance, +50%; p < 0.001). Sternal closure led to further worsening in respiratory mechanics and ventilation heterogeneity, although without any additional significant impact on V/Q matching or oxygenation parameters (PaO<sub>2</sub>/FiO<sub>2</sub> were unchanged after closure).</p><p><strong>Conclusions: </strong>Reestablishing chest wall integrity significantly deteriorates respiratory mechanics and ventilation homogeneity, mirroring improvements initially gained from sternotomy. The absence of additional V/Q mismatch underscores the protective role of pulmonary vascular regulation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Chest Wall on Respiratory Mechanics, Ventilation and Ventilation-Perfusion Matching During Cardiac Surgery.\",\"authors\":\"Ádám L Balogh, Roberta Südy, József Tolnai, Gergely H Fodor, Ferenc Peták, Barna Babik\",\"doi\":\"10.1053/j.jvca.2025.08.039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate how sternotomy and subsequent sternal closure affect respiratory mechanics, ventilation heterogeneity, ventilation-perfusion (V/Q) matching, and oxygenation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Design: </strong>Prospective consecutive self-controlled clinical investigation.</p><p><strong>Setting: </strong>A university hospital.</p><p><strong>Participants: </strong>53 patients undergoing elective cardiac surgery.</p><p><strong>Interventions: </strong>Measurements performed at 4 protocol stages: before sternotomy, immediately after sternotomy, after weaning from CPB, and after sternal closure.</p><p><strong>Measurements and main results: </strong>Respiratory mechanics (airway resistance, tissue damping, and elastance) were assessed using forced oscillations, and ventilation heterogeneity was evaluated via capnographic slopes (phase 2 and phase 3). Physiologic dead spaces (Bohr and Enghoff fractions), V/Q matching, and oxygenation (partial pressure of oxygen [PaO<sub>2</sub>]/fraction of inspired oxygen [FiO<sub>2</sub>] ratio, intrapulmonary shunt fraction) were analyzed as well. Sternotomy significantly improved airway resistance (-30%), tissue damping (-25%), and elastance (-35%), thereby enhancing ventilation homogeneity (phase 3 slope reduced by 20%; p < 0.001). Conversely, CPB markedly deteriorated respiratory mechanics and ventilation efficiency (airway resistance, +45%; elastance, +50%; p < 0.001). Sternal closure led to further worsening in respiratory mechanics and ventilation heterogeneity, although without any additional significant impact on V/Q matching or oxygenation parameters (PaO<sub>2</sub>/FiO<sub>2</sub> were unchanged after closure).</p><p><strong>Conclusions: </strong>Reestablishing chest wall integrity significantly deteriorates respiratory mechanics and ventilation homogeneity, mirroring improvements initially gained from sternotomy. The absence of additional V/Q mismatch underscores the protective role of pulmonary vascular regulation.</p>\",\"PeriodicalId\":15176,\"journal\":{\"name\":\"Journal of cardiothoracic and vascular anesthesia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiothoracic and vascular anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1053/j.jvca.2025.08.039\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2025.08.039","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Impact of Chest Wall on Respiratory Mechanics, Ventilation and Ventilation-Perfusion Matching During Cardiac Surgery.
Objective: To evaluate how sternotomy and subsequent sternal closure affect respiratory mechanics, ventilation heterogeneity, ventilation-perfusion (V/Q) matching, and oxygenation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Interventions: Measurements performed at 4 protocol stages: before sternotomy, immediately after sternotomy, after weaning from CPB, and after sternal closure.
Measurements and main results: Respiratory mechanics (airway resistance, tissue damping, and elastance) were assessed using forced oscillations, and ventilation heterogeneity was evaluated via capnographic slopes (phase 2 and phase 3). Physiologic dead spaces (Bohr and Enghoff fractions), V/Q matching, and oxygenation (partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2] ratio, intrapulmonary shunt fraction) were analyzed as well. Sternotomy significantly improved airway resistance (-30%), tissue damping (-25%), and elastance (-35%), thereby enhancing ventilation homogeneity (phase 3 slope reduced by 20%; p < 0.001). Conversely, CPB markedly deteriorated respiratory mechanics and ventilation efficiency (airway resistance, +45%; elastance, +50%; p < 0.001). Sternal closure led to further worsening in respiratory mechanics and ventilation heterogeneity, although without any additional significant impact on V/Q matching or oxygenation parameters (PaO2/FiO2 were unchanged after closure).
Conclusions: Reestablishing chest wall integrity significantly deteriorates respiratory mechanics and ventilation homogeneity, mirroring improvements initially gained from sternotomy. The absence of additional V/Q mismatch underscores the protective role of pulmonary vascular regulation.
期刊介绍:
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.