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Effect of Ventilation Strategy During Cardiopulmonary Bypass on Arterial Oxygenation and Postoperative Pulmonary Complications After Pediatric Cardiac Surgery: A Randomized Controlled Study

Published:August 31, 2022DOI:https://doi.org/10.1053/j.jvca.2022.08.023

      Objectives

      To compare the effects of 3 ventilation strategies during cardiopulmonary bypass (CPB) on arterial oxygenation and postoperative pulmonary complications (PPCs).

      Design

      A prospective, randomized, controlled study.

      Setting

      A single-center tertiary teaching hospital.

      Participants

      One hundred twenty pediatric patients undergoing elective repair of congenital acyanotic heart diseases with CPB.

      Interventions

      Patients were assigned randomly into 3 groups according to ventilation strategy during CPB as follows: (1) no mechanical ventilation (NOV), (2) continuous positive airway pressure (CPAP) of 5 cmH2O, (3) low tidal volume (LTV), pressure controlled ventilation (PCV), respiratory rate (RR) 20-to-30/min, and peak inspiratory pressure adjusted to keep tidal volume (Vt) 2 mL/kg.

      Measurements and Main Results

      The PaO2/fraction of inspired oxygen (FIO2) ratio and PaO2 were higher in the 5 minutes postbypass period in the LTV group but were nonsignificant. The PaO2/FIO2 ratio and PaO2 were significant after chest closure and 1 hour after arrival to the intensive care unit with a higher PaO2/FIO2 ratio and PaO2 in the LTV group. Regarding the oxygenation index, the LTV group was superior to the NOV group at the 3 time points, with lower values in the LTV group. There were no significant differences in the predictive indices among the 3 groups, including the extubation time, and postoperative intensive care unit stays days. The incidence of PPCs did not significantly differ among the 3 groups.

      Conclusions

      Maintaining ventilation during CPB was associated with better oxygenation and did not reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery.

      Key Words

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      References

        • Apostolakis E
        • Filos KS
        • Koletsis E
        • et al.
        Lung dysfunction following cardiopulmonary bypass.
        J Card Surg. 2010; 25: 47-55
        • Messent M
        • Sullivan K
        • Keogh BF
        • et al.
        Adult respiratory distress syndrome following cardiopulmonary bypass: Incidence and prediction.
        Anesthesia. 1992; 47: 267-268
        • Ng C
        • Wan S
        • Yim A
        • et al.
        Pulmonary dysfunction after cardiac surgery.
        Chest. 2002; 121: 1269-1277
        • Ibañez J
        • Riera M
        • Amezaga R
        • et al.
        Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis.
        J Intensive Care Med. 2016; 31: 34-40
        • Allou N
        • Bronchard R
        • Guglielminotti J
        • et al.
        Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score.
        Crit Care Med. 2014; 42: 1150-1156
        • He S
        • Chen B
        • Li W
        • et al.
        Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review.
        J Thorac Cardiovasc Surg. 2014; 148 (e1-5): 3148-3155
        • Apostolakis EE
        • Koletsis EN
        • Baikoussis NG
        • et al.
        Strategies to prevent intraoperative lung injury during cardiopulmonary bypass.
        J Cardiothorac Surg. 2010; 5: 1-9
        • Rahman A
        • Üstünda B
        • Burma O
        • Özercan İH
        • Çekirdekçi A
        • Bayar MK.
        Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass?.
        Eur J Cardiothorac Surg. 2000; 18: 583-588
        • Hill GE
        • Alonso A
        • Spurzem JR
        • et al.
        Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass–induced inflammation in humans.
        J Thorac Cardiovasc Surg. 1995; 110: 1658-1662
        • Echeverria-Villalobos M
        • Munlemvo DM
        • Fiorda-Diaz J
        • et al.
        Mechanical ventilation and cardiopulmonary bypass: A narrative review of the mechanistic lung-protective measures.
        Vessel Plus. 2019; 3: 33
        • Zupancich E
        • Paparella D
        • Turani F
        • et al.
        Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: A randomized clinical trial.
        J Thorac Cardiovasc Surg. 2005; 130: 378-383
        • Ng CSH
        • Arifi AA
        • Wan S
        • et al.
        Ventilation during cardiopulmonary bypass: Impact on cytokine response and cardiopulmonary function.
        Ann Thorac Surg. 2008; 85: 154-162
        • Beer L
        • Warszawska JM
        • Schenk P
        • et al.
        Intraoperative ventilation strategy during cardiopulmonary bypass attenuates the release of matrix metalloproteinases and improves oxygenation.
        J Surg Res. 2015; 195: 294-302
        • Chan YH.
        Biostatistics 102: Quantitative data–parametric & non-parametric tests.
        Singapore Med J. 2003; 44: 391-396
        • Chan YH.
        Biostatistics 103: Qualitative data-tests of independence.
        Singapore Med J. 2003; 44: 498-503
        • Salama AM
        • Eldegwy MHH
        • Othman H
        • et al.
        Low tidal volume lung ventilation during cardiopulmonary bypass decreases the potential of postoperative lung injury.
        Ain-Shams J Anaesthesiol. 2014; 7: 232-237
        • Chi D
        • Chen C
        • Shi Y
        • et al.
        Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency: A meta-analysis of randomized controlled trials.
        Medicine (Baltimore). 2017; 96: e6454
        • John LCHH
        • Ervine IM.
        Work in progress report - cardiopulmonary bypass: A study assessing the potential benefit of continued ventilation during cardiopulmonary bypass.
        Interact Cardiovasc Thorac Surg. 2008; 7: 14-17
        • Davoudi M
        • Farhanchi A
        • Moradi A
        • et al.
        The effect of low tidal volume ventilation during cardiopulmonary bypass on postoperative pulmonary function.
        J Tehran Univ Hear Cent. 2010; 5: 128-131