الفهرس 
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Abstract
Pulmonary dysfunction is a common complication post cardiac surgery which can affect patient’s outcomes and health economics. It is recognized that many patients post cardiac surgery will have altered pulmonary mechanics which may appear in a wide range of manifestations, from mild atelectasis which is the commonest to life threatening acute lung injury (ALI) or adult respiratory distress syndrome (ARDS).
The use of Alveolar recruitment maneuvers (RM) is very important to increase transpulmonary pressure to promote the opening of the largest possible number of alveoli aiming to improve gas distribution within the alveoli and overcome atelectasis with its subsequent hypoxic complications.
The aim of this study was to evaluate the efficacy of transalveolar pressure measurement (PTA) as an index during a modified stepwise staircase lung recruitment employing adaptive ventilation mode (AVM) in post cardiac surgery hypoxic patients. In the present study, the frequent monitoring of PTA Insp , Cdyn , SpO2 and MBP were used for the detection of the alveolar overdistension, while the monitoring of PTA Exp, Cdyn and SpO2 were used for detection of optimum PEEP.
This study had been carried out in cardiac surgery ICU of Alexandria Main University Hospitals as a prospective case series study on 62 adult patients who were undergone on pump cardiac surgeries. Exclusion of patients with esophygeal pathologies, severe haemodynamic instability, severe obstructive and restrictive lung disease, morbid obese and extremes of age had been done.
In the current study after the arrival of the patient to the ICU and the patient attachment to the mechanical ventilator, the basal ventilator mode used was adaptive ventilation mode (AVM) and ATC was added for artificial airway compensation. Sedation was continued. Basal hypoxic index and ultrasound lung aeration score were done to detect atelectatic hypoxia.
After haemodynamic stabilization of the patient, esophygeal manometer catheter insertion was done then stepwise staircase alveolar recruitment maneuver had been started. The transalveolar pressure was used as a main parameter for the monitoring of the effectiveness and safety of the recruitment maneuver.
Other monitoring parameters during the lung recruitment were dynamic compliance (Cdyn), oxygen saturation (SpO2) and mean arterial blood pressure (MBP).
After the alveolar recruitment maneuver was done. Hypoxic index and ultrasound guided lung aeration score were done to confirm the effectiveness of the recruitment maneuver.
The results of the study revealed the following data:
The PTA Insp detected 96.7 % of the patients with alveolar overdistention which was of high accuracy. The Cdyn detected 62.9 % of the patients with alveolar overdistention which was less accurate than PTA Insp. The SpO2 detected 33.8% of the patients with alveolar overdistention which was less accurate than PTA Insp and Cdyn. The MBP detected 27.4% of the patients with alveolar overdistention which was less accurate than PTA Insp and Cdyn.
The PTA Exp detected 98.3% of the patients alveolar optimum PEEP which was of high accuracy. The Cdyn detected 91.9 % of the patients alveolar optimum PEEP which was less accurate than PTA Exp. The SpO2 detected 24.1% of the patients alveolar optimum PEEP which was less accurate than PTA Exp and Cdyn.
There was significant improvement in the hypoxic index and ultrasound lung aeration score after the recruitment maneuver.
This study concluded that the use of esophygeal manometer for monitoring transalveolar pressure for the effectiveness of the stepwise staircase alveolar recruitment had a significant accuracy to allow safe and effective management of atelectasis in post cardiac surgery patients.