This study is to evaluate the effectiveness of Transesophageal Lung ULtrasound (TELUS) guided recruitment maneuver to reduce lung atelelectasis in cardiac surgery. This is a RCT trial involving a cardiac patient that requiring used of cardiopulmonary bypass machine intraoperatively. These patient will be randomized into either intervention group or control group.
Age between 18 to 70 years old.
Elective cardiac surgery that requires used of transoesophageal ECHO.
New York Heart Association class I or II or III
Preoperative LV ejection fraction >40%
Pregnancy
Contraindication to transoesophageal ECHO - oesophageal tumour, stricture, diverticulum, or recent oesophageal or gastric surgery
Previous lung surgery/ history of lung radiation for cancer
Severe obstructive/ restrictive lung disease- Examples: Patient with home CPAP, frequent hospitalization and ICU admissions due to lung disease
Parallel
Transesophageal lung ultrasound (TELUS) guided recruitment maneuver
Procedure/Surgery1. Lung reinflation guided by transesophageal lung ultrasound (TELUS) after cardiopulmonary bypass weaning 2. TELUS guided recruitment maneuver with continuous positive pressure of 30cmh20 for 20 seconds and 40cmh20 for 20 seconds during sternal wiring
Manual bag lung reinflation
Other interventionAfter weaning of CPB, Lung will be reinflated by 5 deep manual bag infaltion until full inflation observed by the anesthetist. During sternal wiring, Lung ultrasound will be examine - LUNG ultrasound score will be taken- no recruitment maneuver will be done in this contro group (Basically this group of patient is a routine practice in cardiac surgery
Incidence of lung atelectasis intraoperatively after TELUS guided recruitment
assessed by TOE during sternal wiring after recruitment maneuver
Severity of Postoperative pulmonary complications.
Grade 0 - Absence of any complications Grade 1 - Cough, dry * Microatelectasis: abnormal lung findings and temperature \> 37.5°C without other documented cause; normal CXR Grade 2 - Cough, productive * Bronchospasm * Hypoxemia (SpO2 ≤ 90%) at room air * Atelectasis: gross radiological confirmation plus either temperature \> 37.5°C or abnormal lung findings * Hypercarbia (PaCO2 \> 50 mmHg), requiring treatment Grade 3 - Pleural effusion, resulting in thoracentesis * Pneumonia- requiring change of antibiotic * Pneumothorax * Noninvasive ventilation- Re-intubation , with period of ventilator dependence (non-invasive or invasive ventilation) ≤ 48 hours Garde 4 - Ventilatory failure: postoperative ventilator dependence exceeding 48 hours, or reintubation with ventilator dependence exceeding 48 hours Grade 5 Death before hospital discharge
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