Protection of lungs in the course of surgeries with artificial blood circulation

V.V. Bober, S.E. Domnin, V.V. Pichugin
Keywords: lungs protection, cardiopulmonary bypass, ventilation of the lungs, pulmonary artery perfusion.
Medicinskij al'manah, 2017, issue 3, pages 123-127.

Over the last 50 years the main researches were concentrated on improvement of results of myocardial
protection and methods of lungs protection at operations with cardiopulmonary bypass (CPB) were substantially
ignored. Although severe lung injury after CPB is uncommon, it remains a significant cause of
morbidity and mortality with a major impact on health care expenditures. The etiology of pulmonary dysfunction
after cardiac surgery is multifactorial; however, combined ischemia and reperfusion during CPB and
inflammatory mediators or activated inflammatory cells reperfused to the lung after CPB are major factors
to induce pulmonary dysfunction, as supported by the ample experimental and clinical evidence. Despite
advances in studies of acute lung injury, many molecular mechanisms remain unclear, and no pharmacologic
agents targeting identified molecular pathways have been clinically effective. Some encouraging
results have shown that maintaining lung ventilation and pulmonary artery perfusion and modification of the
CPB circuit during CPB potentially can minimize postoperative lung injury. However, we still need further
elucidation of the underlying mechanism of CPB-induced lung injury to refine therapeutic strategies for
patients who receive cardiac surgery.

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V.V. Bober, S.E. Domnin, V.V. Pichugin Protection of lungs in the course of surgeries with artificial blood circulation. Medicinskij al'manah 2017; (3): 123–127,