Effects of Positive End-Expiratory Pressure on Mechanical Ventilation Duration after Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Borges, Daniel Lago; Nina, Vinicius José da Silva; Baldez, Thiago Eduardo Pereira; Costa, Maria do Rosário da Silva Ramos; Santos, Natália Pereira dos; Lima, Ilka Mendes; Lula, Josimary Lima da Silva

doi:10.5761/atcs.cr.13-00069

Cited by 12 publications

(15 citation statements)

References 20 publications

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“…This issue should be performed in further studies with PEEP hemodynamics after CAB surgery. Moreover, some studies have demonstrated that higher levels of PEEP required more sedatives and increase the mechanical ventilation time and compromise the mechanical ventilation withdrawal [ 6 , 12 , 13 ]. Our data support the notion that high PEEP levels directly affect tissue oxygenation in patients after cardiac surgery, even with preserved cardiac function and without surgery complications.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery

et al. 2017

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BackgroundCardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO2) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery.MethodsSeventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO2/FiO2 ratio <200) were enrolled. Heart rate, mean arterial pressure, arterial and venous blood samples were measured at intensive care unit and PEEP was increased to 12 cmH2O for 30 min.ResultsAs expected, PEEP12 improved arterial oxygenation and PaO2/FiO2 ratio (p < 0.0001). Reduction in ScvO2 was observed between PEEP5 (63 ± 2%) and PEEP12 (57 ± 1%; p = 0.01) with higher values of blood lactate in PEEP12 (p < 0.01). No hemodynamic effects (heart rate, mean arterial pressure, SpO2; p > 0.05) were related.ConclusionIncreased PEEP after cardiac surgery decreased ScvO2 and increased blood lactate, even with higher O2 delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery

et al. 2017

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“…1). One study [40] did not report the number of randomized patients and the intermediate PEEP groups of four studies [23,24,31,32] were excluded, hence the mismatch between the total number of included patients and the sum of the patients in the two groups. Data on the primary outcome were complete in the published reports of the studies.…”

Section: Resultsmentioning

confidence: 99%

Higher Versus Lower Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

Pettenuzzo

Boscolo

Cassai

et al. 2021

Preprint

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Background: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the association of higher positive end-expiratory pressure (PEEP), as opposed to lower PEEP, with hospital mortality in adult intensive care unit (ICU) patients undergoing invasive mechanical ventilation for reasons other than acute respiratory distress syndrome (ARDS). Methods: We performed an electronic search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science from inception until December 18, 2020 with no language restrictions. In addition, a research-in-progress database and grey literature were searched. Results: We identified 22 RCTs (2225 patients) comparing higher PEEP (1007 patients) with lower PEEP (991 patients). No statistically significant association between higher PEEP and hospital mortality was observed (risk ratio 1.02, 95% confidence interval 0.89-1.16; I2 = 0%, p = 0.62; low certainty of evidence). Among secondary outcomes, higher PEEP was associated with better oxygenation, higher respiratory system compliance, and lower risk of hypoxemia and ARDS occurrence. Furthermore, barotrauma, hypotension, duration of ventilation, lengths of stay, and ICU mortality were similar between the two groups. Conclusions: In our meta-analysis of RCTs, higher PEEP, compared with lower PEEP, was not associated with mortality or duration of ventilation in patients without ARDS receiving invasive mechanical ventilation, despite being associated with improved oxygenation and lower occurrence of ARDS.

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“…This decline might be due to better levels of arterial oxygenation in ICU after heart surgery in early times by applying 10 cm H 2 O PEEP. Many studies have confirmed that high levels of PEEP can improve arterial oxygenation after heart surgery ( 22 , 23 , 25 ).…”

Section: Discussionmentioning

confidence: 97%

“…PEEP is applied along with an increase in respiratory factors, lung volumes and improved gas and alveolar exchanges ( 16 , 17 ), and is recommended for the main treatment of collapse created in patients under anesthesia with healthy lungs ( 18 , 19 ), atelectasis treatment and improved arterial oxygenation ( 20 , 21 ). Some studies on the benefits of PEEP different levels reported that elevated values could lead to a reduction in ventilator duration and increased survival odds ratio ( 22 ). A study on the adverse effects of high levels (PEEP>10 cm of water) reported an increase in ventilation duration, prolonged intubation ( 23 ) and increased length of hospitalization ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

Setak-Berenjestanaki

Bagheri-Nesami

Baradari

et al. 2018

Med. J. Islam. Republic Iran

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Background: The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery. Methods: This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery. Results: The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003). Conclusion: The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.

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Effects of Positive End-Expiratory Pressure on Mechanical Ventilation Duration after Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Cited by 12 publications

References 20 publications

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery

Higher Versus Lower Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

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