Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Abstract

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Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial

“…In contrast, a small study of fifty‐nine patients prospectively randomized to continuous ventilation and no ventilation, during CABG on CPB, showed there was no statistically significant difference in most of the inflammatory makers (IL‐6, IL8, IL‐10, and lactate) . A recent meta‐analysis for patients undergoing cardiac surgery and received ventilation during CPB included seventeen trials with 1162 patients, showed that ventilation during CPB significantly increased post‐CPB PaO 2 /FiO 2 ratio, but there was no sufficient evidence to show that ventilation during CPB could influence long‐term prognosis of these patients …”

Mechanical ventilation and cardiopulmonary bypass: a narrative review of the mechanistic lung protective measures

“…Thirty-five (n = 35) articles were excluded due to no CPB surgery or intraoperative ventilation was discussed (n = 27), case reports (n = 2), protocol design (n = 2), trials involving cardiac surgeries in children (n = 1), thesis (n = 1), and no full-text available (n = 2). Therefore, 13 articles were included for further description in our qualitative analysis: systematic review and meta-analysis (n = 1) [2] , meta-analysis (n = 1) [8] , randomized clinical trials or RCTs (n = 3) [9][10][11] , prospective observational (n = 1) [12] , and reviews (n = 7) [4][5][6][13][14][15][16] . Figure 1 describes the flow diagram corresponding to our search.…”

“…Moreover, the ratio between the arterial oxygen partial pressure (PaO 2 ) and the inspired fraction of oxygen (FiO 2 ) or PaO 2 /FiO 2 ratio was reported in the only prospective observational study [12] . Likewise, one meta-analysis by Chi et al [8] included 17 trials and 1,162 patients undergoing cardiac surgery evaluating the oxygenation index (PaO 2 /FiO 2 ratio) and the alveolar to arterial oxygen difference (AaDO 2 ) after CPB. Rate of PPCs, shunt fraction, hospital LOS, and postoperative AaDO 2 (4 h after CPB) were also estimated.…”

“…Protective ventilation strategies are associated with improved lung mechanics, decreased pro-inflammatory cytokines, and reduced postoperative intubation time and ICU LOS Bignami et al [16] Chi et al [8] Meta-analysis NA Impact of mechanical ventilation during CPB on PPCs when compared to non-ventilated patients Mechanical ventilation during CPB results in an improved oxygenation and gas exchanged. However, comparable incidences of PPCs and hospital LOS have been reported among groups…”

Ventilation Strategy During Cardiopulmonary Bypass: A Moving Target

“…Over the past decade, numerous studies have sought to compare ventilation during CPB to identify an optimal strategy. Recent systemic reviews have examined, variously, CPAP versus conventional treatment (ie, no ventilation while on bypass 7 and, more broadly, "ventilation" versus "no ventilation" during CPB) 8 and have elicited similar findings-that some form of ventilation or delivery of CPAP during CPB appears to be better than none with regard to measured oxygenation parameters. These studies also have not been able to identify a significant difference in clinical outcomes such as postoperative respiratory morbidity or length of stay.…”