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Pizov, R.(1), Weiss, Y. G.(1), Oppenheim-Eden, A.(1), Glickman, H.(2), Goodman, S.(1), Koganov, Y.(1), Barak, V.(5), Merin, G.(3), Kramer, M. R.(4)

(1) Department of Anesthesiology and CCM (3) Cardiothoracic Surgery (4) Pulmonology (5) Immunology Laboratory of Oncology Hadassah Medical Center

(2) Applied Statistics Laboratory, Department of Statistics The Hebrew University of Jerusalem

January 2000


Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is associated with increased risk of lung injury. There is no consensus about the ventilatory management during CPB. The present study investigated the effect of two ventilatory regimens on CPB associated lung injury in patients undergoing coronary artery bypass grafting. Methods: Patients were randomized to receive 100% oxygen (Oxygen group) or 50% oxygen (Air group) throughout surgery. During CPB the patient's lungs were flushed with oxygen (Oxygen group) or air (Air group). The lung injury was evaluated by measurement PaO2/FiO2 ratio, cytokine levels (TNF-alpha and IL-8) in Blood and BAL fluid.

Results: The lowest PaO2/FiO2 value was observed 40 minutes after CPB in both groups, 201+/-86 and 194+/- 99 mm Hg (mean+/-SD) in the Oxygen and Air groups respectively. PaO2/FiO2 values six hours after CPB were not different from baseline in the Air group, but remained significantly lower (359 +/- 63 and 298+/-78, p=0.0127) in the Oxygen group. Blood TNF-alpha and IL-8 levels rose during surgery in both groups. BAL levels of IL-8 did not change, while TNF-alpha increased only in the Oxygen group (p=0.0352).

Conclusions: We observed a significant decrease of oxygenation in the early post CPB period in both groups of patients, with delay in recovery in patients treated with 100% oxygen. A larger increase of the proinflammatory cytokines was found in patients treated with higher oxygen concentration. High oxygen concentrations during surgery with CPB should be used only when specifically required.


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