Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial

Bolzan, Douglas W.; Trimer, Renata; Begot, Isis; Nasrala, Mara L.S.; Forestieri, Patrícia; Méndez, Vanessa Marques Ferreira; Arena, Ross; Gomes, Walter J.; Guizilini, Solange

doi:10.1053/j.jvca.2015.09.001

Cited by 8 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous investigations demonstrated that OLS is more effective in preserving key clinical parameters and/or outcomes when compared to CMV in patients with preserved cardiac function [1] . Therefore, the novel aspect of the current study is the evaluation of the OLS on pulmonary function, functional capacity, and clinical outcomes in a population with impaired left ventricular function.…”

Section: Discussionmentioning

confidence: 99%

“…The endpoints and the operative technique in this study followed the standard employed in our former report [1] .…”

Section: Methodsmentioning

confidence: 99%

“…Time on assisted ventilation, postoperative in-hospital length of stay, and respiratory events (pleural effusion, pneumothorax, atelectasis, and pneumonia) were documented according to our previous methodology [1] . Chest roentgenograms, obtained preoperatively and on POD1, 3 and 5, were evaluated by a radiologist blinded to the patient's group allocation.…”

Section: Methodsmentioning

confidence: 99%

“…Open lung ventilation strategy (OLS) consists of the application of short periods of high inspiratory pressures (to open the collapsed alveoli) associated with a relatively high level of positive end-expiratory pressure (PEEP) - to keep the alveoli open - and low tidal volumes [1] . Recently, this strategy has demonstrated to be efficient in promoting faster improvement in functional and clinical parameters ( i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, this strategy has demonstrated to be efficient in promoting faster improvement in functional and clinical parameters ( i.e. , pulmonary function, functional capacity, and clinical outcomes) following off-pump coronary artery bypass grafting (OPCAB) when compared to conventional mechanical ventilation (CMV) [1] . In this previous study, no differences were found between the OLS initiated intra-operatively and after intensive care unit (ICU) arrival.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Bolzan

Gomes

Rocco

et al. 2016

Brazilian Journal of Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

ObjectiveTo compare pulmonary function, functional capacity and clinical outcomes amongst three groups of patients with left ventricular dysfunction following off-pump coronary artery bypass, namely: 1) conventional mechanical ventilation (CMV); 2) late open lung strategy (L-OLS); and 3) early open lung strategy (E-OLS).MethodsSixty-one patients were randomized into 3 groups: 1) CMV (n=21); 2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS (n=20) initiated after intubation. Spirometry was performed at bedside on preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated preoperatively and on POD1. The 6-minute walk test was applied on the day before the operation and on POD5.ResultsBoth the open lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when compared to the CMV group (P<0.05). The 6-minute walk test distance was more preserved, shunt fraction was lower, and PaO2 was higher in both open-lung groups (P<0.05). Open-lung groups had shorter intubation time and hospital stay and also fewer respiratory events (P<0.05). Key measures were significantly more favorable in the E-OLS group compared to the L-OLS group.ConclusionBoth OLSs (L-OLS and E-OLS) were able to promote higher preservation of pulmonary function, greater recovery of functional capacity and better clinical outcomes following off-pump coronary artery bypass when compared to conventional mechanical ventilation. However, in this group of patients with reduced left ventricular function, initiation of the OLS intra-operatively was found to be more beneficial and optimal when compared to OLS initiation after intensive care unit arrival.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The endpoints and the operative technique in this study followed the standard employed in our former report [1] .…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Bolzan

Gomes

Rocco

et al. 2016

Brazilian Journal of Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials

Deng

Tan

Zhao

et al. 2020

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume V T improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low V T ventilation remain unclear. Methods: Several electronic databases were searched to identify RCTs that focused on comparison between low V T strategy and conventional mechanical ventilation (CMV), or between two different low V T strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated. Results: Compared with CMV, low V T ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5e8 cm H 2 O]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEPþRMs: 0.39 [0.19, 0.78]; and high PEEP [!9 cm H 2 O]þRMs: 0.34 [0.14, 0.79]). Low V T ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEPþRMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEPþRMs: 0.41 [0.15, 0.97]), whilst low V T ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]). Conclusions: The combination of low V T ventilation and moderate-to-high PEEP (!5 cm H 2 O) seems to confer lung protection in surgical patients undergoing general anaesthesia. Clinical trial registration: PROSPERO (CRD42019144561) Editor's key pointsThe authors used a network meta-analytical method to allow comparison and ranking of intraoperative ventilation strategies.Of the ventilation strategies examined, tidal volume 8 ml kg À1 with PEEP !5 cm H 2 O was found to be associated with a reduced risk of postoperative pulmonary complications. High-quality clinical investigations are needed to clarify the optimal levels of PEEP and to identify the best recruitment strategies.

show abstract

Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass

Viceconte

Rocco

Pauletti

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial

Cited by 8 publications

References 16 publications

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials

Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass

Contact Info

Product

Resources

About