BJA Advance Access originally published online on April 19, 2004
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British Journal of Anaesthesia, 2004, Vol. 92, No. 6 808-813
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery
1 Department of Anaesthesiology and 2 Department of Cardiac Surgery, University of Munich, Germany
*Corresponding author. E-mail: alwin.goetz{at}med.uni-muenchen.de
Background. Mid-line thoracotomy is a standard approach for cardiac surgery. However, little is known how this surgical approach affects the interaction between the circulation and mechanical ventilation. We studied how mid-line thoracotomy affects cardiac filling volumes and cardiovascular haemodynamics, particularly variations in stroke volume and pulse pressure caused by mechanical ventilation.
Methods. We studied 19 patients during elective coronary artery bypass surgery. Before and after mid-line thoracotomy, we measured arterial pressure, cardiac index (CI) and global end-diastolic volume index (GEDVI) by thermodilution, left ventricular end-diastolic area index (LVEDAI) by transoesophageal echocardiography and the variations in left ventricular stroke volume and pulse pressure during ventilation by arterial pulse contour analysis.
Results. After thoracotomy, CI increased from 2.3 (0.4) to 2.9 (0.6) litre min–1 m–2, GEDVI increased from 605 (110) to 640 (94) litre min–1 m–2, and LVEDAI increased from 9.2 (3.7) to 11.2 (4.1) cm2 m–2. All these changes were significant. In contrast, stroke volume variation (SVV) decreased from 10 (3) to 6 (2)% and pulse pressure variation (PPV) decreased from 11 (3) to 5 (3)%. Before thoracotomy, SVV and PPV significantly correlated with GEDVI (both P<0.01). When the chest was open, similar significant correlations of SVV (P<0.001) and PPV (P<0.01) were found with GEDVI.
Conclusion. Thoracotomy increases cardiac filling and preload. Further, thoracotomy reduces the effect of mechanical ventilation on left ventricular stroke volume. However, also under open chest conditions, SVV and PPV are preload-dependent.
Br J Anaesth 2004; 92: 808–13
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