FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2100082500> ?p ?o ?g. }

• W2100082500 endingPage "215" @default.
• W2100082500 startingPage "213" @default.
• W2100082500 abstract "Great advances in respiratory management have recently widened the indication for cardiovascular surgery for patients with pulmonary dysfunction. We describe a patient with an extremely low vital capacity caused by severe chest deformity who tolerated aortic root replacement as a result of adequate respiratory management, including bilevel positive airway pressure (BiPAP) ventilation. A 39-year-old man with Marfan syndrome was scheduled to undergo aortic root replacement for annuloaortic ectasia and aortic insufficiency. He had been receiving home oxygen therapy for 10 years and nocturnal use of nasal continuous positive airway pressure ventilation for 1 year because of frequent episodes of respiratory failure. On admission, he showed respiratory distress at grade IV of the Hugh-Jones classification. Spirometry showed a severe restrictive pattern: vital capacity of 1080 mL (28% of predicted value) and forced expiratory volume in 1 second of 890 mL. Arterial blood gases (ABGs) under 1 L of oxygen inhalation revealed metabolically compensated hypercapnia: pH, 7.41; Paco2, 60.8 mm Hg; Pao2, 80.4 mm Hg; base excess, 10.9 mmol/L. Chest radiography showed cardiomegaly with mild lung congestion and severe scoliosis (Figure 1). Computed tomographic (CT) scans revealed the dilated aortic root (62 mm in diameter) and marked elongation of the descending aorta along the vertebral bodies (Figure 2). Transthoracic echocardiography revealed a redundant tricuspid aortic valve with severe regurgitation. The left ventricular ejection fraction was 45%, as estimated by ventriculography.Figure 2CT scan reveals dilatation of the aortic root (62 mm in diameter) and marked elongation of the descending aorta along the vertebral bodies.View Large Image Figure ViewerDownload (PPT) At the time of sternotomy, we paid particular attention to avoiding lung injury and to not opening the pleural spaces. After establishment of cardiopulmonary bypass, the aortic root was replaced with a composite graft by use of the Carrel patch technique because aortic leaflets were severely degenerated. Weaning from bypass was uneventful. ABGs on admission to the intensive care unit were favorable: pH, 7.38; Paco2, 50.1 mm Hg; Pao2, 167.2 mm Hg; base excess, 4.4 mmol/L (synchronized intermittent mandatory ventilation; fraction of inspired oxygen of 0.5; respiratory rate of 12 breaths/min; tidal volume of 460 mL; positive end-expiratory pressure of 4 cm H2O). The trachea was extubated 4 hours after the admission, when he was completely alert and oriented. However, he had respiratory distress immediately after the extubation, and his respiratory rate exceeded 40 breaths/min. Subsequent ABGs with 10 L of oxygen showed respiratory acidosis: pH, 7.299; Paco2, 57.1 mm Hg; Pao2, 130.7 mm Hg; base excess, 1.4 mmol/L. Therefore, we applied BiPAP ventilatory support (BiPAP vision, Respironics, Inc) through a face mask. The inspiratory and expiratory pressures were set at 10 and 4 cm H2O, respectively. The respiratory rate decreased to the mid-20s in beats per minute, and ABGs showed an improvement of acidemia: pH, 7.359; Paco2, 52.3 mm Hg; Pao2, 118.3 mm Hg; base excess, 3.1 mmol/L. We could terminate BiPAP ventilation the next morning and resumed nasal continuous positive airway pressure ventilation for subsequent respiratory support. The patient was discharged from the hospital without any complications. Spirometry examined before discharge showed no remarkable change compared with the preoperative values. Pectus excavatum and scoliosis, commonly associated with Marfan syndrome, cause restrictive pulmonary dysfunction, although the connective tissue defects in Marfan syndrome seem to have little clinical effect on such dysfunction.1Streeten E.A. Murphy E.A. Pyeritz R.E. Pulmonary function in the Marfan syndrome.Chest. 1987; 91: 408-412Crossref PubMed Scopus (57) Google Scholar Accordingly, patients with severe chest deformities are still predisposed to a risk of respiratory deterioration, even after a successful extubation. Avoidance of reintubation is of great importance because mortality increases more than 7-fold with reintubation and subsequent mechanicalventilation.2Epstein S.K. Ciubotaru R.L. Wong J.B. Effect of failed extubation on the outcome of mechanical ventilation.Chest. 1997; 112: 186-192Crossref PubMed Scopus (533) Google Scholar The BiPAP ventilator is one of relatively novel noninvasive ventilators and has gained increasingly widespread acceptance in acute and chronic respiratory failure.3Tokuda Y. Matsumoto M. Sugita T. et al.Bilateral diaphragmatic paralysis after aortic surgery with topical hypothermia ventilatory assistance by means of nasal mask bilevel positive pressure.J Thorac Cardiovasc Surg. 2003; 125: 1158-1159Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar However, the rationale of BiPAP application after elective extubation is still controversial. Ferrer and colleagues4Ferrer M. Esquinas A. Arancibia F. et al.Noninvasive ventilation during persistent weaning failure a randomized controlled trial.Am J Respir Crit Care Med. 2003; 168: 70-6Crossref PubMed Scopus (325) Google Scholar reported that BiPAP facilitated weaning from mechanical ventilation, whereas Esteban and associates5Esteban A. Frutos-Vivar F. Ferguson N.D. et al.Noninvasive positive-pressure ventilation for respiratory failure after extubation.N Engl J Med. 2004; 350: 2452-2460Crossref PubMed Scopus (612) Google Scholar insisted BiPAP did not prevent reintubation in patients who had respiratory failure after extubation. The maximum feature of BiPAP ventilation is the ability to provide ventilatory assistance noninvasively for alert and spontaneously breathing patients. It is expected that inspiratory pressure support augments ventilation, even in patients with decreased vital capacity, and positive end-expiratory pressure restores functional residual capacity. As a result, the work of breathing decreases. We believe decrease of respiratory rate was the clinical sign of reduced respiratory workload in the current patient. In conclusion, we report a case of severe pulmonary dysfunction caused by chest deformity in a patient who tolerated aortic root replacement as a result of adequate respiratory management. Our experience should reassure patients with severe respiratory dysfunction necessitating cardiovascular surgery." @default.
• W2100082500 created "2016-06-24" @default.
• W2100082500 creator A5020047408 @default.
• W2100082500 creator A5025199631 @default.
• W2100082500 creator A5035020564 @default.
• W2100082500 creator A5041978602 @default.
• W2100082500 creator A5056106260 @default.
• W2100082500 creator A5075824931 @default.
• W2100082500 date "2005-07-01" @default.
• W2100082500 modified "2023-09-28" @default.
• W2100082500 title "Aortic root replacement in a patient with pulmonary dysfunction caused by severe chest deformity associated with Marfan syndrome" @default.
• W2100082500 cites W1965897430 @default.
• W2100082500 cites W2035203787 @default.
• W2100082500 cites W2069334674 @default.
• W2100082500 cites W2086979102 @default.
• W2100082500 cites W2154881752 @default.
• W2100082500 cites W2161926701 @default.
• W2100082500 doi "https://doi.org/10.1016/j.jtcvs.2005.02.031" @default.
• W2100082500 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/15999068" @default.
• W2100082500 hasPublicationYear "2005" @default.
• W2100082500 type Work @default.
• W2100082500 sameAs 2100082500 @default.
• W2100082500 citedByCount "3" @default.
• W2100082500 countsByYear W21000825002016 @default.
• W2100082500 crossrefType "journal-article" @default.
• W2100082500 hasAuthorship W2100082500A5020047408 @default.
• W2100082500 hasAuthorship W2100082500A5025199631 @default.
• W2100082500 hasAuthorship W2100082500A5035020564 @default.
• W2100082500 hasAuthorship W2100082500A5041978602 @default.
• W2100082500 hasAuthorship W2100082500A5056106260 @default.
• W2100082500 hasAuthorship W2100082500A5075824931 @default.
• W2100082500 hasBestOaLocation W21000825001 @default.
• W2100082500 hasConcept C126322002 @default.
• W2100082500 hasConcept C141071460 @default.
• W2100082500 hasConcept C164705383 @default.
• W2100082500 hasConcept C2776042228 @default.
• W2100082500 hasConcept C2779980429 @default.
• W2100082500 hasConcept C2780333948 @default.
• W2100082500 hasConcept C2780663194 @default.
• W2100082500 hasConcept C42219234 @default.
• W2100082500 hasConcept C71924100 @default.
• W2100082500 hasConceptScore W2100082500C126322002 @default.
• W2100082500 hasConceptScore W2100082500C141071460 @default.
• W2100082500 hasConceptScore W2100082500C164705383 @default.
• W2100082500 hasConceptScore W2100082500C2776042228 @default.
• W2100082500 hasConceptScore W2100082500C2779980429 @default.
• W2100082500 hasConceptScore W2100082500C2780333948 @default.
• W2100082500 hasConceptScore W2100082500C2780663194 @default.
• W2100082500 hasConceptScore W2100082500C42219234 @default.
• W2100082500 hasConceptScore W2100082500C71924100 @default.
• W2100082500 hasIssue "1" @default.
• W2100082500 hasLocation W21000825001 @default.
• W2100082500 hasLocation W21000825002 @default.
• W2100082500 hasOpenAccess W2100082500 @default.
• W2100082500 hasPrimaryLocation W21000825001 @default.
• W2100082500 hasRelatedWork W1990210055 @default.
• W2100082500 hasRelatedWork W2002120878 @default.
• W2100082500 hasRelatedWork W2003938723 @default.
• W2100082500 hasRelatedWork W2047967234 @default.
• W2100082500 hasRelatedWork W2118496982 @default.
• W2100082500 hasRelatedWork W2439875401 @default.
• W2100082500 hasRelatedWork W2914276787 @default.
• W2100082500 hasRelatedWork W3029648831 @default.
• W2100082500 hasRelatedWork W4238867864 @default.
• W2100082500 hasRelatedWork W2525756941 @default.
• W2100082500 hasVolume "130" @default.
• W2100082500 isParatext "false" @default.
• W2100082500 isRetracted "false" @default.
• W2100082500 magId "2100082500" @default.
• W2100082500 workType "article" @default.