OBJECTIVE: To ascertain if protective ventilation can attenuate the damaging postoperative pulmonary effects of cardiopulmonary bypass (increases in airway pressure, decreases in lung compliance, and increases in shunt). DESIGN: Prospective, randomized clinical trial. SETTING: Single university hospital. PARTICIPANTS: Twenty-five patients undergoing elective coronary artery bypass graft procedure and early extubation. INTERVENTIONS: Thirteen patients received conventional mechanical ventilation (CV; respiratory rate, 8 breaths/min; tidal volume, 12 mL/kg; fraction of inspired oxygen [FIO2], 1.0; positive end-expiratory pressure [PEEP], +5), and 12 patients received protective mechanical ventilation (PV; respiratory rate, 16 breaths/min; tidal volume, 6 mL/kg; FIO2, 1.0; PEEP, +5). Perioperative anesthetic and surgical management were standardized. Various pulmonary parameters were determined twice perioperatively: 10 minutes after intubation and 60 minutes after arrival in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: The mean postoperative increase in peak airway pressure in group CV was significantly larger than the mean postoperative increase in peak airway pressure in group PV (7.1 v 2.4 cm H2O; p < 0.001). Group CV experienced significant postoperative increases in plateau airway pressure (p = 0.007), but group PV did not (p = 0.644). The mean postoperative decrease in dynamic lung compliance in group CV was significantly larger than the mean postoperative decrease in dynamic lung compliance in group PV (14.9 v 5.5 mL/cm H2O; p = 0.002). Group CV experienced significant postoperative decreases in static lung compliance (p = 0.014), but group PV did not (p = 0.645). Group CV experienced significant postoperative increases in shunt (15.5% to 21.4%; p = 0.021), but group PV did not (18.4% to 21.2%; p = 0.265). CONCLUSIONS: Data indicate that protective ventilation decreases pulmonary damage caused by mechanical ventilation in normal and abnormal lungs. The results of this investigation indicate that protective ventilation may also help attenuate the postoperative pulmonary dysfunction (increases in airway pressure, decreases in lung compliance, and increases in shunt) commonly seen in patients after exposure to cardiopulmonary bypass.
RCT Entities:
OBJECTIVE: To ascertain if protective ventilation can attenuate the damaging postoperative pulmonary effects of cardiopulmonary bypass (increases in airway pressure, decreases in lung compliance, and increases in shunt). DESIGN: Prospective, randomized clinical trial. SETTING: Single university hospital. PARTICIPANTS: Twenty-five patients undergoing elective coronary artery bypass graft procedure and early extubation. INTERVENTIONS: Thirteen patients received conventional mechanical ventilation (CV; respiratory rate, 8 breaths/min; tidal volume, 12 mL/kg; fraction of inspired oxygen [FIO2], 1.0; positive end-expiratory pressure [PEEP], +5), and 12 patients received protective mechanical ventilation (PV; respiratory rate, 16 breaths/min; tidal volume, 6 mL/kg; FIO2, 1.0; PEEP, +5). Perioperative anesthetic and surgical management were standardized. Various pulmonary parameters were determined twice perioperatively: 10 minutes after intubation and 60 minutes after arrival in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: The mean postoperative increase in peak airway pressure in group CV was significantly larger than the mean postoperative increase in peak airway pressure in group PV (7.1 v 2.4 cm H2O; p < 0.001). Group CV experienced significant postoperative increases in plateau airway pressure (p = 0.007), but group PV did not (p = 0.644). The mean postoperative decrease in dynamic lung compliance in group CV was significantly larger than the mean postoperative decrease in dynamic lung compliance in group PV (14.9 v 5.5 mL/cm H2O; p = 0.002). Group CV experienced significant postoperative decreases in static lung compliance (p = 0.014), but group PV did not (p = 0.645). Group CV experienced significant postoperative increases in shunt (15.5% to 21.4%; p = 0.021), but group PV did not (18.4% to 21.2%; p = 0.265). CONCLUSIONS: Data indicate that protective ventilation decreases pulmonary damage caused by mechanical ventilation in normal and abnormal lungs. The results of this investigation indicate that protective ventilation may also help attenuate the postoperative pulmonary dysfunction (increases in airway pressure, decreases in lung compliance, and increases in shunt) commonly seen in patients after exposure to cardiopulmonary bypass.
Authors: Sugantha Sundar; Victor Novack; Karinne Jervis; S Patrick Bender; Adam Lerner; Peter Panzica; Feroze Mahmood; Atul Malhotra; Daniel Talmor Journal: Anesthesiology Date: 2011-05 Impact factor: 7.892
Authors: Ary Serpa Neto; Nicole P Juffermans; Sabrine N T Hemmes; Carmen S V Barbas; Martin Beiderlinden; Michelle Biehl; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Samir Jaber; Alf Kozian; Marc Licker; Wen-Qian Lin; Stavros G Memtsoudis; Dinis Reis Miranda; Pierre Moine; Domenico Paparella; Marco Ranieri; Federica Scavonetto; Thomas Schilling; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N Weingarten; Esther K Wolthuis; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Ann Transl Med Date: 2018-01