A study assessing the potential benefit of continued ventilation during cardiopulmonary bypass

John, Lindsay C.H.; Ervine, Ian M.

doi:10.1510/icvts.2007.158451

Cited by 47 publications

(36 citation statements)

References 13 publications

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“…They all failed to document a significant difference with regard to ΔA–aO 2 . Only John et al 21 reported less extravascular lung fluid accumulation and a decreased period of ventilation.…”

Section: Discussionmentioning

confidence: 97%

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Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Durukan¹,

Gürbüz²,

Salman³

et al. 2013

CVJA

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IntroductionCardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia–reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount of intrapulmonary shunt. Atelectasis also causes post-perfusion lung injury. In this study, we aimed to document the effects of continued low-frequency ventilation on the inflammatory response following cardiopulmonary bypass and on outcomes, particularly pulmonary function.MethodsFifty-nine patients subjected to elective coronary bypass surgery were prospectively randomised to two groups, continuous ventilation (5 ml/kg tidal volume, 5/min frequency, zero end-expiratory pressure) and no ventilation, during cardiopulmonary bypass. Serum interleukins 6, 8 and 10 (as inflammatory markers), and serum lactate (as a marker for pulmonary injury) levels were studied, and alveolar–arterial oxygen gradient measurements were made after the induction of anaesthesia, and immediately, one and six hours after the discontinuation of cardiopulmonary bypass.ResultsThere were 29 patients in the non-ventilated and 30 in the continuously ventilated groups. The pre-operative demographics and intra-operative characteristics of the patients were comparable. The serum levels of interleukin 6 (IL-6) increased with time, and levels were higher in the non-ventilated group only immediately after discontinuation of cardiopulmonary bypass. IL-8 levels significantly increased only in the non-ventilated group, but the levels did not differ between the groups. Serum levels of IL-10 and lactate also increased with time, and levels of both were higher in the non-ventilated group only immediately after the discontinuation of cardiopulmonary bypass. Alveolar–arterial oxygen gradient measurements were higher in the non-ventilated group, except for six hours after the discontinuation of cardiopulmonary bypass. The intubation time, length of stay in intensive care unit and hospital, postoperative adverse events and mortality rates were not different between the groups.ConclusionDespite higher cytokine and lactate levels and alveolar–arterial oxygen gradients in specific time periods, an attenuation in the inflammatory response following cardiopulmonary bypass due to low-frequency, low-tidal volume ventilation could not be documented. Clinical parameters concerning pulmonary and other major system functions and occurrence of postoperative adverse events were not affected by continuous ventilation.

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Section: Discussionmentioning

confidence: 97%

“…Gagnon et al 4 determined a tidal volume of 3 ml/kg during CPB and John et al 21 5 ml/kg. Boldt et al 22 continued normal ventilation during CPB.…”

Section: Discussionmentioning

confidence: 99%

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Durukan¹,

Gürbüz²,

Salman³

et al. 2013

CVJA

View full text Add to dashboard Cite

show abstract

“…In contrast to this, another experimental study showed that continuous ventilation during CPB provided no significant improvement in pulmonary vascular resistance, respiratory index, or oxygen tensions [91]. More recently, John et al [92] showed in their randomized study that continued ventilation during CPB by tidal volume of 5 ml/Kg resulted significant smaller extravascular lung water and a shorter extubation-time. To date, the evidence for clear benefits of maintaining ventilation alone during CPB is inconsistent, with most studies showing no significant preservation of lung function [5,88].…”

Section: Methodology and Strategy For Management Of Lung Dysfunction mentioning

confidence: 99%

Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

Apostolakis

Koletsis

Baikoussis

et al. 2010

J Cardiothorac Surg

130

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During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

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“…Intraoperative use of inhaled pulmonary vasodilators has been described, and showed to improve cardiac output and decrease pulmonary artery pressures in patients undergoing cardiac surgery . Intraoperative ventilation while on cardiopulmonary bypass has also been described and shown lead to lower levels of postoperative lung water, less pulmonary inflammation, quicker time to extubation . To our knowledge, this is the first study to describe the elective application of both iEpo with continuous intraoperative low tidal volume ventilation while on CPB during surgery for complex cases of valvular IE.…”

Section: Discussionmentioning

confidence: 99%

Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

et al. 2019

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Background and Aim To compare outcomes of patients treated with inhaled epoprostenol and low tidal volume ventilation during cardiopulmonary bypass with those who did not receive this medication in the operating room at all, and those who received it as a rescue therapy at the end of the case. Methods Retrospective chart review between 2014 and 2017, follow‐up included the entire hospital stay. Results Seventy‐one patients were included, and mean age was 54 years. 78.9% of the patients were male. Procedures included 96% (n = 68) aortic valve replacement, 28% (n = 20) reconstruction of the intravalvular fibrosa, and 13% (n = 9) repair of an endocarditis‐related intracardiac fistula. Patients who received epoprostenol (iEpo) (treatment and rescue groups), when compared with the control group had more intra‐aortic balloon pump placement (23% vs 2.5%, P = .018), open chest after surgery (32% vs 7.5%, P = .012), and duration of mechanical ventilation (8.3 ± 2.7 vs. 2.4 ± 0.4 days, P = 0.01). There was no significant difference between the two groups in terms of extracorporeal circulatory support (6.5% vs 2.5%, P = .577) and hospital death (13% vs 10%, P = .72). In a subanalysis, hospital death and duration of mechanical ventilation were higher in the recue group when compared with the treatment group (P = .004 and .056, respectively). Conclusions Prophylactic application of iEpo with low tidal volume ventilation for an anticipated complex endocarditis operation may contribute to favorable outcome when compared with postoperative epoprostenol rescue.

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A study assessing the potential benefit of continued ventilation during cardiopulmonary bypass

Cited by 47 publications

References 13 publications

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topic

Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

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