Lung-Centered Open Heart Surgery: A Call for a Paradigm Change

Frontiers in Cardiovascular Medicine

Edward Gologorsky¹ 

关键词: cardiopulmonary bypass;    postoperative complications;    pulmonary dysfunction;    capnography;    ischemia–;    reperfusion injury;   

DOI  :  10.3389/fcvm.2016.00012

学科分类：心脏病和心血管学

来源: Frontiers

【 摘 要 】

“The time has come,” in the famous words of Lewis Carroll, “to talk of many things,” and we would like to talk about many things that lead to severe pulmonary dysfunction after cardiac surgery. The term is broad indeed and is usually taken to represent a wide gamut ranging from well-compensated abnormalities of respiratory mechanics to symptomatic hypoxemia secondary to ventilation/perfusion mismatching to more significant prolonged ventilator dependency to dreaded “respiratory cripple.” Overwhelming financial and societal costs aside, prolonged ventilator dependency carries the staggering in-house mortality in excess of 40% (1). The incidence and severity was reported to vary widely between centers, partially because of disparate definitions, but significantly because of poorly defined “hospital quality” characteristics (2, 3). We agree with those who look for the causes outside the various demographic characteristics, but rather focus on performance, perioperative surgical and anesthetic techniques, experience and expertise of surgical perioperative care team (4, 5). Let us concentrate on what we actually do in the operating room and see what can be improved.

【 授权许可】

CC BY