• J. Cardiothorac. Vasc. Anesth. · May 2020

    The Effect of Common Interventions in the Intensive Care Unit on Right Ventricular Function After Cardiac Surgery-An Intervention Study.

    • Lars Grønlykke, André Korshin, Finn Gustafsson, Jens Chr Nilsson, and Hanne Berg Ravn.
    • Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: lars.groenlykke@regionh.dk.
    • J. Cardiothorac. Vasc. Anesth. 2020 May 1; 34 (5): 1211-1219.

    ObjectiveCritical care therapy after cardiac surgery includes interventions to aid pulmonary and cardiac function. The aim of this study was to investigate the effect of such interventions on right ventricular function (RVF).DesignThis was a prospective intervention study.SettingThis study was conducted at a single tertiary university hospital.ParticipantsThirty elective coronary artery bypass graft (CABG) patients were studied in the intensive care unit (ICU) following CABG surgery.InterventionsThe following interventions were investigated: Trendelenburg position; positive end-expiratory pressure (PEEP) 0, 5, and 10 cmH2O; increased oxygen fraction; and AAI, DDD, and VVI pacing.Measurements And Main ResultsTransesophageal echocardiography and a pulmonary artery catheter were used to assess hemodynamics and RVF. Transesophageal echocardiography measures included right ventricular (RV) fractional area change, RV ejection fraction, RV stroke volume (SV), and RV global longitudinal strain (RV-GLS). Trendelenburg increased global echocardiographic measures of RVF as well as cardiac output (CO) 0.44 L/min (95% CI: 0.21-0.67). Increasing PEEP from 0 to 10 reduced SV and consequently CO by 0.41 L/min. Pulmonary vascular resistance was not changed by increasing PEEP. AAI or DDD pacing (15 beats above baseline) increased CO 0.35 L/min (95% CI 0.07-0.63). In contrast VVI pacing decreased CO by 24% (1.2 L/min [95% CI 0.9-1.6]). Applying 100% O2 did not affect hemodynamics, but RV-GLS was improved -4.4% (95% CI: -6.9 to -1.9).ConclusionIn patients with normal RVF undergoing CABG, several routine interventions in the ICU affect RVF, in particular PEEP and VVI pacing, which induces clinically important reductions in stroke volume.Copyright © 2019 Elsevier Inc. All rights reserved.

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