Recruitment maneuver application following pulmonary endarterectomy; does it have any impact on reperfusion lung injury and outcome?

Gürcü M. E., Baysal P. K., Yanar K., Bekiroğlu G. N., Erkılınç A., Yıldızeli B.

ANNALS OF CLINICAL AND ANALYTICAL MEDICINE, cilt.12, sa.7, ss.794-799, 2021 (ESCI) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 12 Sayı: 7
  • Basım Tarihi: 2021
  • Doi Numarası: 10.4328/acam.20751
  • Dergi Adı: ANNALS OF CLINICAL AND ANALYTICAL MEDICINE
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI)
  • Sayfa Sayıları: ss.794-799
  • Anahtar Kelimeler: Chronic Thromboembolic Pulmonary Hypertension, Pulmonary Endarterectomy, Recruitment Maneuver, Reperfusion Lung Injury, Antioxidant Molecule, END-EXPIRATORY PRESSURE, EXTRACELLULAR-SUPEROXIDE DISMUTASE, IMMUNOCYTOCHEMICAL LOCALIZATION, THROMBOENDARTERECTOMY, RAT, ATELECTASIS, HYPOXEMIA, ISCHEMIA, FAILURE, DISEASE
  • Marmara Üniversitesi Adresli: Evet

Özet

Aim: The only curative treatment of chronic thromboembolic pulmonary hypertension is Pulmonary Endarterectomy. This surgery, may result in ischemia- reperfusion lung injury, which may be related with higher mortality. The aim of the study was to assess the effect of intraoperative recruitment maneuver on ischemia-reperfusion lung injury following Pulmonary Endarterectomy.

Material and Methods: The study was designed as a randomized prospective study with the approval of the Clinical Trials Ethics Committee of our hospital. Between January 2019 and December 2019, 60 patients were included in the study. Randomization was performed using a computer program. The patients were divided into two groups: the study group, in which the recruitment maneuvers were performed and the control group. The primary outcome of this study was to compare the biochemical markers of ischemia-reperfusion injury and oxygenation in patients with and without recruitment maneuvers.

Results: In the recruitment group, arterial pO2 value was 312±82 mmHg, while it was 268±85 mmHg in the control group (p: 0.044). Malondialdehyde, a biomarker of ischemia-reperfusion injury in Broncho Alveolar Lavage fluid were 5±1 and 4±0 (p:0.008) in the control and recruitment groups, and Superoxide Dismutase were 10±2 and 11±1 (p: 0.011) in the control and recruitment groups, respectively.

Discussion: During pulmonary endarterectomy operations, the application of recruitment maneuvers at high inflation pressures after cardiopulmonary bypass, where reperfusion injury may occur, results in a decrease in ischemia-reperfusion injury markers especially in broncho alveolar lavage fluid, and an increase in antioxidant molecules.

Keywords: Chronic Thromboembolic Pulmonary Hypertension; Pulmonary Endarterectomy; Recruitment Maneuver; Reperfusion Lung Injury; Antioxidant Molecule