Preventing and managing perioperative pulmonary complications following cardiac surgery

García-Delgado, Manuel; Navarrete-Sánchez, I.; Colmenero, Manuel

doi:10.1097/aco.0000000000000059

Cited by 67 publications

(49 citation statements)

References 61 publications

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“…There were 2 trials that investigated the relationship of different FiO 2 levels (FiO 2 = 0.21; 1.0) with the PaO 2 /FiO 2 [22,32] and they suggested that perioperative hyperoxia was potentially harmful by increasing the expression of reactive oxygen species and decreasing receptors in cells. [34] Considering the lung injury caused by high FiO 2 , we excluded the group that using 100% oxygen in those 2 trials.…”

Section: Discussionmentioning

confidence: 99%

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Chi

Chen²,

Shi³

et al. 2017

Medicine

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Section: Discussionmentioning

confidence: 99%

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Chi

Chen²,

Shi³

et al. 2017

Medicine

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“…As observed by García-Delgado et al (40) at any rate, strategies that are recommended to limit the effect of CPB on lung injury should include a reduction in CPB duration or the use of off-pump CABG, heparin-coated circuits, leucocyte depletion or intra-operative ultrafiltration. Since safety of restricted hemoglobin target (7-8 mg/dL) has been proved (41), minimization of blood product administration should be pursued to decrease the risk of TRALI.…”

Section: Preventive Measuresmentioning

confidence: 99%

“…The use of higher PEEP levels (10 cmH 2 O for the first 4 hours followed by PEEP levels of 5 cmH 2 O until tracheal extubation) improved pulmonary compliance and oxygenation compared to lower PEEP level (5 cmH The anesthetic technique significantly impacts on time to extubation, also. Early extubation, generally considered to be that which is performed during the first 6-8 hours once the preoperative homeostatic state has been reestablished (40), offers a substantial advantage in terms of accelerated recovery, shorter intensive care unit and hospital stay, suggesting that efforts to reduce extubation time are cost-effective (65). Cardiac surgical patients in whom low tidal volumes are administered are more likely to undergo early extubation (37.3% vs. 20.3%; P=0.02) and less likely to require re-intubation (1.3% vs. 9.5%; P=0.03) (66).…”

Section: Non-surgical Techniquesmentioning

confidence: 99%

Acute respiratory distress syndrome after cardiac surgery

2016

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Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure, with a mortality rate approaching 40% in the general population and 80% in the subset of patients undergoing cardiac surgery. The increased risk of ARDS in these patients has traditionally been associated with the use of cardiopulmonary bypass (CPB), the need for blood product transfusions, large volume shifts, mechanical ventilation and direct surgical insult. Indeed, the impact of ARDS in the cardiac population is substantial, affecting not only survival but also in-hospital length of stay and long-term physical and psychological morbidity. No patient undergoing cardiac surgery can be considered ARDS risk-free. Early identification of those at higher risk is crucial to warrant the adoption of both surgical and non-surgical specific preventative strategies. The present review focuses on epidemiology, risk assessment, pathophysiology, prevention and management of ARDS in the specific setting of patients undergoing cardiac surgery.

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“…Over recent years, several preventive lung-protective strategies have been investigated and proposed [6, 7]: ultrafiltration to remove neutrophils [8], controlled hemodilution (with a hematocrit higher than 23%), steroids [9] and adjusting MV settings during CPB, such as the application of positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) of 5–15 cmH 2 O, low tidal-high frequency ventilation (100 acts/min), the application of 100% oxygen inspired fraction (FiO 2 ), and bilateral CPB which involves using the lungs for blood oxygenation [10]. …”

Section: Introductionmentioning

confidence: 99%

Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

Bignami

Guarnieri

Saglietti

et al. 2017

Trials

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BackgroundThere is no consensus on which lung-protective strategies should be used in cardiac surgery patients. Sparse and small randomized clinical and animal trials suggest that maintaining mechanical ventilation during cardiopulmonary bypass is protective on the lungs. Unfortunately, such evidence is weak as it comes from surrogate and minor clinical endpoints mainly limited to elective coronary surgery. According to the available data in the academic literature, an unquestionable standardized strategy of lung protection during cardiopulmonary bypass cannot be recommended. The purpose of the CPBVENT study is to investigate the effectiveness of different strategies of mechanical ventilation during cardiopulmonary bypass on postoperative pulmonary function and complications.Methods/designThe CPBVENT study is a single-blind, multicenter, randomized controlled trial. We are going to enroll 870 patients undergoing elective cardiac surgery with planned use of cardiopulmonary bypass. Patients will be randomized into three groups: (1) no mechanical ventilation during cardiopulmonary bypass, (2) continuous positive airway pressure of 5 cmH2O during cardiopulmonary bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2–3 ml/Kg of ideal body weight and positive end-expiratory pressure of 3–5 cmH2O during cardiopulmonary bypass. The primary endpoint will be the incidence of a PaO2/FiO2 ratio <200 until the time of discharge from the intensive care unit. The secondary endpoints will be the incidence of postoperative pulmonary complications and 30-day mortality. Patients will be followed-up for 12 months after the date of randomization.DiscussionThe CPBVENT trial will establish whether, and how, different ventilator strategies during cardiopulmonary bypass will have an impact on postoperative pulmonary complications and outcomes of patients undergoing cardiac surgery.Trial registrationClinicalTrials.gov, ID: NCT02090205. Registered on 8 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2008-2) contains supplementary material, which is available to authorized users.

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Preventing and managing perioperative pulmonary complications following cardiac surgery

Cited by 67 publications

References 61 publications

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Acute respiratory distress syndrome after cardiac surgery

Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

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