Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial

• Published in: Journal of cardiothoracic surgery 2021-10, Vol.16 (1), p.1-319, Article 319
• Main Authors: Zhang, Meng-Qiu, Liao, Yu-Qi, Yu, Hong, Li, Xue-Fei, Shi, Wei, Jing, Wei-Wei, Wang, Zai-Li, Xu, Yi, Yu, Hai
• Format: Article
• Language: English
• Subjects: Blood; Body weight; Cardiac surgery; Cardiopulmonary bypass; Clinical trials; Complications; Coronary artery bypass; Fraction of inspired oxygen; Heart; Heart surgery; Hospitals; Intubation; Mechanical ventilation; Medical personnel; Mortality; Patients; Postoperative period; Postoperative pulmonary complications; Respiration; Respiratory rate; Surgery; Variance analysis; Ventilation; Ventilators
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-021-01699-1

Background To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO.sub.2) had an impact on the occurrence of postoperative pulmonary complications (PPCs). Methods A total of 413 adult patients undergoing elective cardiac surgery with CPB were randomly assigned into three groups: 138 in the NoV group (received no mechanical ventilation during CPB), 138 in the LOV group (received a tidal volume (V.sub.T) of 3-4 ml/kg of ideal body weight with the respiratory rate of 10-12 bpm, and the positive end-expiratory pressure of 5-8 cmH.sub.2O during CPB; the FiO.sub.2 was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO.sub.2 was 80%). Results The primary outcomes were the incidence and severity of PPCs during hospitalization. The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). And there was also no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. The LOV group was observed a lower proportion of moderate and severe pulmonary complications (grade [greater than or equai to] 3) than the NoV group (23.1% vs. 44.2%, P = 0.001). Conclusion Maintaining ventilation during CPB did not reduce the incidence of PPCs in patients undergoing cardiac surgery. Trial registration: Chinese Clinical Trial Registry ChiCTR1800015261. Prospectively registered 19 March 2018. Keywords: Cardiac surgery, Cardiopulmonary bypass, Mechanical ventilation, Fraction of inspired oxygen, Postoperative pulmonary complications