Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial

Abstract

Background To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs). Methods A total of 413 adult patients undergoing elective cardiac surgery with CPB were randomly assigned into three groups: 138 in the NoV group (received no mechanical ventilation during CPB), 138 in the LOV group (received a tidal volume (VT) of 3–4 ml/kg of ideal body weight with the respiratory rate of 10–12 bpm, and the positive end-expiratory pressure of 5–8 cmH2O during CPB; the FiO2 was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO2 was 80%). Results The primary outcomes were the incidence and severity of PPCs during hospitalization. The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). And there was also no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. The LOV group was observed a lower proportion of moderate and severe pulmonary complications (grade ≥ 3) than the NoV group (23.1% vs. 44.2%, P = 0.001). Conclusion Maintaining ventilation during CPB did not reduce the incidence of PPCs in patients undergoing cardiac surgery. Trial registration: Chinese Clinical Trial Registry ChiCTR1800015261. Prospectively registered 19 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25982

Effect of mechanical ventilation during cardiopulmonary bypass on end-expiratory lung volume in the perioperative period of cardiac surgery: an observational study

“…For the same reasons, we cannot rule out that different results may have been observed in our study with a more selected "at risk" population. Contrariwise, a recent randomized study showed that the use of ventilation with low FiO 2 (30%) during CPB was associated with less incidence of severe post-operative pulmonary complications than no ventilation (29 vs. 59%) [23]. Differences between studies (including ours) may explain this discrepancy.…”

A study of mechanical ventilation in the ICU after cardiac surgery: a bibliometric analysis

“…Some researchers have confirmed that the use of sedation, and sucralfate, and the appropriate use of antibiotics reduces the risk of respiratory and related pneumonia after patients are transferred to the ICU after surgery, thereby avoiding PMV (17). Other studies have found that the use of invasive and non-invasive sequential mechanical ventilation effectively reduces the time of mechanical ventilation and reduces the incidence of respiratory complications (18,19).…”

Incidence of Post-Operative Pulmonary Complications in Patients Undergoing Cardiac Surgery with Low Tidal Volume Ventilation

“…Moderate and severe pulmonary problems were 21% less common in the LOV group than in the NoV group in a prior trial (23% vs. 44%, P = 0.001). 15 In order to demonstrate the protective link between ventilation and better postoperative respiratory outcomes in cardiac surgery, the current study included a larger sample size of patients than earlier investigations. While the risk reduction was nearly as good as anticipated, the incidence of events was lower than projected.…”