Abstract
ImportancePostoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients.ObjectivesTo investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients.Main Outcomes and MeasuresA single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared.ResultsA higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min–1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m–2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively).Conclusions and RelevanceCompared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.
Highlights
MATERIALS AND METHODSPostoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality and resource utilization in cardiac surgery patients (Biccard et al, 2018)
Compared to the pressure control ventilation (PCV) group, the arterial partial pressure of O2 (PaO2)/fraction of inspired oxygen (FiO2) was significantly higher after 4 h in patients of Airway pressure release ventilation (APRV) group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group
Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients
Summary
MATERIALS AND METHODSPostoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality and resource utilization in cardiac surgery patients (Biccard et al, 2018). Patients undergoing cardiopulmonary bypass (CPB) frequently experience hypoxemia and pulmonary complications after surgery and may develop acute respiratory distress syndrome (Cox et al, 2000; Stephens et al, 2013). Despite the advanced CPB techniques and the preventive measures used to avoid respiratory complications after cardiac surgery (Apostolakis et al, 2010; García-Delgado et al, 2014), postoperative acute respiratory distress syndrome manifests in 10-20% of patients (Gajic et al, 2011), and its overall mortality remains high (Habashi and Andrews, 2004; Kor et al, 2014). APRV was originally described as a mode to treat acute lung injury in patients and attempt to maintain the level of airway pressure without reducing cardiac function, delivering mechanical breaths without excessive airway pressure and allowing unrestricted spontaneous ventilation. A randomized controlled trial was designed to compare APRV with conventional PCV
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