Abstract
BackgroundTo determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs).MethodsA 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 (VT) 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 cmH2O during CPB; the FiO2 was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO2 was 80%).ResultsThe 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 ≥ 3) than the NoV group (23.1% vs. 44.2%, P = 0.001).ConclusionMaintaining 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. http://www.chictr.org.cn/showproj.aspx?proj=25982
Highlights
To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs)
The patients were randomized into three groups: (1) the NoV group: no ventilation during CPB; (2) the LOV group: participants received a low VT of 3–4 ml/ kg of ideal body weight (IBW) with the respiratory rate (RR) of 10–12 bpm, and the positive end-expiratory pressure (PEEP) of 5–8 c mH2O during CPB; the Fraction of inspired oxygen (FiO2) is 30% with a flow of 2 L/min; (3) the HOV group: the FiO2 is 80% with a flow of 2 L/min; the ventilation parameter settings were same as the LOV group
The incidence of moderate and severe pulmonary complications that occurred in LOV group was significantly lower than that in NoV group (P = 0.001) (Fig. 2)
Summary
To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs). The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). There was no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. Postoperative pulmonary complications (PPCs), including pneumonia, pleural effusion, atelectasis, etc., are common, with reported incidence of up to 59.2% [2]. The effect of low VT ventilation with different FiO2 during CPB in patients having cardiac surgery is still unclear
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