Marqueurs biologiques de l’infarctus du myocarde

Diagnosis of postoperative myocardial infarction is often difficult, based on tools with a low sensitivity (clinical symptoms, EKG), or with a low specifity (old biomarkers, echocardiographic abnormalities) or inadequate for clinical practice (scintigraphy). Since 1995, clinicians may use more cardiospecific markers (troponin) allowing to modify strategy for postoperative myocardial infarction diagnosis. The aim of this review is to resume such an attitude.     

Comparaison de trois modes ventilatoires au cours du transport postopératoire immédiat du patient opéré de chirurgie cardiaque

Objective

Compare three ventilatory strategies during the immediate postoperative transfer of cardiac surgical patient.

Study design

Prospective, comparative and observational study.

Patients and methods

After approval by our local ethical committee, 330 patients undergoing on-pump cardiac surgery were consecutively included. Patients suffering from chronic obstructive pulmonary disease, exhibiting intraoperative hypoxemia or requiring nitric oxide were excluded. The ventilatory mode was left at the discretion of the anesthesiologist and included: controlled mechanical ventilation (FiO₂ = 1, N = 124) or (FiO₂ = 0.6, N = 106), and manual ventilation using rebreathing bag (N = 100). A blood gas analysis was performed immediately prior to connecting patient at ventilator at the arrival in ICU.

Results

The mean duration of transfer was 3.9 ± 1.4 min. Invasive pressure monitoring was used in all patients. The pulse oxymetry and electrocardiogram were respectively used in 78% and 24% of patients. PaO₂ values less than 100 mmHg and those more than 300 mmHg were more frequently found in patients ventilated by rebreathing bag (42%) and mechanical ventilation FiO₂ 1 (52%), respectively. No significant difference was found between groups regarding PaCO₂ values.

Conclusion

When rebreathing bag is used for transfer in ICU, severe decrease in PaO₂ may be observed. In absence of intraoperative hypoxemia, a mechanical ventilation with FiO₂ 0.6 seems to be the most suitable ventilatory strategy for such short immediate postoperative transfer.