Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

Abstract

OBJECTIVES The aim of this study was to evaluate if a ‘protective’ (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB). METHODS This is a single-centre prospective, interventional study, including children with CHD under the age of 5 years, undergoing open-heart surgery with a CPB >60 min, in hypothermia, haemodynamically stable, and without evident genetic abnormalities. Assist-control ventilation (tidal volume of 4 ml/kg, 10 breaths/min, positive end-expiratory pressure 5 cmH2O and FiO2 0.21) was applied in a cohort of patients during CPB. We compared clinical outcomes and in fully ventilated versus non-ventilated (control) patients. Propensity score was used to weigh ventilated and control groups to correct for the effect of other confounding clinical variables. Clinical and ventilation parameters and lung inflammatory biomarkers in tracheal aspirates were measured. The primary outcome was the postoperative intubation time of more or less than 48 h. RESULTS We included 140 children (53 ventilated, 87 non-ventilated) with different CHD. There were no deaths or adverse events in ventilated patients. Using a weighted generalized linear model, we found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time [estimate 0.13 (95% confidence interval, –0.08; 0.35), P = 0.22]. CONCLUSIONS Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe and harmless. However, no significant advantages were found when compared to non-ventilated patients in terms of postoperative ventilation time.

Evaluation of the effect of ventilation strategies during cardiopulmonary bypass on postoperative pulmonary complication in pediatric cardiac surgery

“…Additionally, the current study found no statistically significant differences between groups as regarding type of cardiac operations and duration of surgery. In harmony to our results, Zhang et al 2021 [11] examined 413 adult patients undergoing elective heart surgery with CPB classified into three groups: N V group, LOV group, and HOV group. They found no statistically significant differences between the three groups in terms of (age, gender, BMI, comorbidities), intraoperative factors, and (Surgical type, Anesthetics administration, Duration of surgery).…”

“…Moreover , the current study found no statistically significant differences amoung the 3 groups as regarding number of patients developed atelectasis after surgery although number of patients who developed atelectasis in NV group was greater than LTV group and CPAP group. Zhang et al 2021 [11] in his study found no statistically significant differences amoung the 3 groups as regarding number of patients developed atelectasis after surgery (P=0.09) although number of patients who developed atelectasis in HOV group was greater than LTV group and NoV group.…”

“…On the other hand no differences in hospital mortality, early respiratory failure, ventilation support beyond day 2, or reintubation were observed between the ventilating group and the control group (no ventilation) in the recently published MECANO research, which involved a sizable number of patients (n=1501) [14]. Zhang et al 2021 [11] found no significant difference in surgical site infection, ICU intubation time, ICU stay, hospital stay, and 30-d mortality among the three groups.…”

Effect of static lung expansion on pulmonary function following cardiopulmonary bypass in children

“…Broader implications for clinical practice guidelines: Successful static lung dilation practices can provide new evidence and recommendations for clinical practice guidelines to help physicians better manage and treat patients receiving CPBS [ 1 , 7 , 8 ]. At present, there are relatively few studies on lung protection strategies during CPB in pediatric populations [ 9 ]. Due to the differences between children's physiological characteristics and adults', specific lung protection strategies need to be developed for different age groups.…”

Padrões hemodinâmicos pulmonares em pacientes pediátricos com defeitos septais cardíacos congênitos: relação com mediadores inflamatórios e a presença não suspeitada de vírus respiratórios

“…A pressão arterial pulmonar (PAP) sistólica, diastólica e média foi aferida de forma direta, antes e após a CEC, sendo a última medida aferida na vigência de oxido nítrico inalatório. Note-se que as medidas de PAP foram realizadas com estratégia de ventilação mecânica de rotina (120,121) ventilação mecânica foi utilizada estratégia protetora, com volume corrente de 6ml/kg de peso (122) , e óxido nítrico inalatório (NOi), na dose de 20 ppm, salvo em pacientes que necessitaram de ventilação prolongada por razões outras que não a HP. A intubação orotraqueal e ventilação mecânica foram mantidas por pelo menos 72 horas.…”