Effect of different ventilation strategies during cardiopulmonary bypass on cardiac de-airing in congenital cardiac surgery: A trans-esophageal echocardiography comparative study

• Published in: Egyptian journal of anaesthesia 2022-12, Vol.38 (1), p.694-700
• Main Authors: Hayes, Salwa M. S., Magdy, Mohamed, El Rahamawy, Ghada A., Elgamal, Mohamed A., Elnegeery, Naglaa A.
• Format: Article
• Language: English
• Subjects: cardiopulmonary bypass; Congenital heart disease; de-airing process; Transesophageal echocardiography
• ISSN: 1110-1849; 1687-1804; 1110-1849
• DOI: 10.1080/11101849.2022.2149075

This study was conducted to evaluate the efficacy of using either low tidal ventilation or continuous positive pressure ventilation on the quality of de-airing procedure during cardiopulmonary bypass (CPB) surgery for correction of congenital heart diseases. This study was conducted on 48 children under the age of 6 years scheduled for elective correction of congenital heart diseases. Patients were randomly allocated into three groups. In the low tidal volume (LTV) group, ventilator was set to a respiratory rate of 5 breaths per minute with tidal volume of 2-3 ml/kg of ideal body weight and a positive end-expiratory pressure of 3-5 cmH 2 O. In continuous positive airway pressure (CPAP) group, oxygen flow was maintained at 0.5 L/min during CPB, ventilator was shut off and the adjustable pressure-limiting valve (APL) was set at a pressure of 10 cmH 2 O. In the no ventilation (NV) group, ventilator was shut off, fresh flow air was completely stopped and APL was adjusted on spontaneous position. The primary outcome was the total de-airing time using transesophageal echocardiography. The total de-airing time was significantly decreased in CPAP group, with the shortest duration of 246.88 ± 5.40 sec in comparison to both LTV group with 284.25 ± 6.52 sec and NV group with 452.12 ± 26.6 sec with p-value 0.001. Use of CPAP 10 cmH 2 O ventilation during CPB surgery for correction of congenital heart diseases could improve the process of de-airing by decreasing the total time needed to de-air heart chambers.