Effect of Different Levels of Peep on Oxygenation during Non-Invasive Ventilation in Patients Submitted to CABG Surgery: Randomized Clinical Trial

Abstract

IntroductionDuring and after coronary artery bypass grafting, a decline in multifactor lung function is observed. Due to this fact, some patients may benefit from non-invasive ventilation after extubation targeting lung expansion and consequently improved oxygenation.ObjectiveTo test the hypothesis that higher levels of positive end expiration pressure during non-invasive ventilation improves oxygenation in patients undergoing coronary artery bypass grafting.MethodsA randomized clinical trial was conducted at Instituto Nobre de Cardiologia in Feira de Santana. On the first day after surgery, the patients were randomized: Group PEEP 10, Group PEEP 12 and Group PEEP 15 who underwent non-invasive ventilation with positive end expiration pressure level. All patients were submitted to analysis blood pressure oxygen (PaO2), arterial oxygen saturation (SaO2) and oxygenation index (PaO2/FiO2).ResultsThirty patients were analyzed, 10 in each group, with 63.3% men with a mean age of 61.1±12.2 years. Mean pulmonary expansion pre-therapy PaO2 was generally 121.9±21.6 to 136.1±17.6 without statistical significance in the evaluation among the groups. This was also present in PaO2/FiO2 and SaO2. Statistical significance was only present in pre and post PEEP 15 when assessing the PaO2 and SaO2 (P=0.02). ConclusionBased on the findings of this study, non-invasive ventilation with PEEP 15 represented an improvement in oxygenation levels of patients undergoing coronary artery bypass grafting.

Optimal Positive End Expiratory Pressure Levels in Ventilated Patients Without Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis and Systematic Review of Randomized Controlled Trials

“…Meanwhile, the year of publication widely varied across the studies, with 12 of them published before 2000 ( Table 1 ). RoB was high in 18 ( 15 – 17 , 20 , 23 , 24 , 27 , 28 , 30 – 32 , 34 – 38 , 40 , 41 ) and low in 10 ( 5 , 10 , 18 , 19 , 21 , 22 , 25 , 26 , 29 , 33 ) trials. The high RoB was attributed to blinding of participants, personnel and outcome assessors ( Figure 3 ).…”

“…Eleven eligible studies, with 1,648 patients, reported on PFR ( 5 , 10 , 15 , 20 – 22 , 24 , 25 , 32 – 34 ), with 6 of them (comprising 347 patients) focusing on post-cardiac surgery patients ( 5 , 10 , 21 , 22 , 24 , 33 ). Results of RoB are shown in Figure 3 and Supplementary Figure 1A .…”

Impact of Lung Expansion Therapy Using Positive End-Expiratory Pressure in Mechanically Ventilated Patients Submitted to Coronary Artery Bypass Grafting

“…In a recent study, Cordeiro et al demonstrated that this application of high levels of PEEP also improved oxygenation during the application of therapy in non-invasive ventilation in patients after CABG [14] .…”

Higher PEEP versus Lower PEEP Strategies for Patients in ICU without Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

“…After carefully reading the full text of the remaining 63 articles, we found 39 of them inappropriate for the following reasons: 1) not ICU patients (n = 3); 2) disequilibrium of other ventilation parameters (n = 7); 3) not RCT (n = 3); 4) animal trials (n = 2); 5) receiving different PEEP within single patients (n = 15); 6) including patients with ARDS or age under 18 (n = 2); 7) retrospective studies (n = 4); 8) intraoperative studies (n = 2) and 9) full article unavailable. Therefore, we nally analyzed 24 studies [5,8,[10][11][12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] .…”

“…Although there was one meta-analysis published in 2016 investigating the possible effect of high PEEP, the quality of evidence was low and insu cient [15] . In our present meta-analysis, we added four recent RCTs [33][34][35] including one largest RCT concerning high PEEP usage in non-ARDS patients [14] . Moreover, given that most of the selected patients underwent operations, especially cardiac ones, we also assessed the impact of high PEEP on postoperative chest-tube drainage and RBC usage, with no signi cant difference found.…”