prolonged intensive care therapyWe recruited 56 consecutive patients following elective prosthetic replacement of the thoracoabdominal aorta. Six patients were excluded because they could not be extubated within < 48 h. Of these, five patients developed paraplegia, and four of them died, while the other two patients survived after prolonged intensive care therapy.

Accordingly, 50 patients were randomized (control group, 25 patients; study group, 25 patients). The subcategories of thoracoabdominal aortic aneurysms (using the Crawford classification) were evenly distributed within the control and study groups (type I, 5 vs 3 patients, respectively; type II, 9 vs 9 patients, respectively; type III, 11 vs 13 patients, respectively; difference not significant). Demographic data and data on the surgical procedures are shown in Table 1. It is worth mentioning that in both the study and control groups 7 of the 25 patients were active smokers. The incidences of a preoperative diagnosis of COPD were not different (control group, 12 of 25 subjects; study group, 13 of 25 patients; difference not significant) between both groups. One patient in the study group had undergone a tracheotomy for prolonged mechanical ventilation after pneumonia several years before. There were no other statistically significant differences between the control group and the study group. However, in all patients intraoperative catecholamine therapy was necessary, and the mean blood loss exceeded 4 L.