Elena Bignami1, Antonio Di Lullo2, Francesco Saglietti3, Marcello Guarnieri3, Vincenzo Pota4, Sabino Scolletta5, Carlo Alberto Volta6, Luigi Vetrugno7, Franco Cavaliere8, Luigi Tritapepe9. 1. Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy. 2. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. University of Milan-Bicocca, School of Medicine and Surgery, Monza, Italy. 4. Department of Women, Child, General and Surgical Surgery, University of Campania Luigi Vanvitelli, Naples, Italy. 5. Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University of Siena, Siena, Italy. 6. Department of Morphology Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy. 7. Department of Medicine, University of Udine, Udine, Italy. 8. Institute of Anesthesia and Intensive Care, Sacro Cuore Catholic University, A. Gemelli Polyclinic, Rome, Italy. 9. Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: Management of mechanical ventilation is a key issue in the prevention of postoperative pulmonary complications (PPCs) and the improvement of surgical outcome. This is especially true in cardiac surgery where the use of the cardiopulmonary bypass (CPB) increases the risk of lung injury. In the last years a growing number of studies have shown that protective ventilation has led to excellent results. However, the literature in this regard is lacking in cardiac surgery and there are no univocal guidelines in this sense. The aim of this survey was to investigate the actual clinical practice about ventilation techniques used in the Italian cardiac surgery centers. METHODS: A questionnaire of 32-item was sent to 69 Italian cardiac surgery centers, 56 of which return a completed form (81.2%). The questionnaire was assembled by three independent researchers and the final version was e-mailed to all members of the SIAARTI (Italian society of anesthesia resuscitation and intensive care medicine) Study Group on Cardiothoracic and Vascular Anesthesia. The answers were collected using a Google Forms sheet. In case of multiple questionnaires returned from the same center (i.e., different physicians from the same center responded) the head of department was asked to give a definite answer. Furthermore, for the 17 centers who reported multiple questionnaires, no large differences were found between the responses of different doctors belonging to the same center (12.3%±4.2% of discordant answers). RESULTS: Intraoperatively, patients were ventilated with a tidal volume (TV) of 6-8 mL/kg (91.1% of centers), a positive end-expiration pressure of 3-5 cmH2O (76.8% of centers) and a fraction of inspired oxygen (FiO2) of 50-80% (60.7% of centers). During the CPB, the "stop ventilation" technique was frequently adopted (73.2%). Before the discharge from the intensive care unit (ICU) non-invasive ventilation (NIV) was never applied in 32.1% of the centers, but it was used in 46.4% of patients with postoperative complications. CONCLUSIONS: This study shows a significant heterogeneity in ventilatory techniques among the Italian centers during CPB, whereas in the other surgical time the majority of the responding centers adopted a protective mechanical ventilation strategy.
BACKGROUND: Management of mechanical ventilation is a key issue in the prevention of postoperative pulmonary complications (PPCs) and the improvement of surgical outcome. This is especially true in cardiac surgery where the use of the cardiopulmonary bypass (CPB) increases the risk of lung injury. In the last years a growing number of studies have shown that protective ventilation has led to excellent results. However, the literature in this regard is lacking in cardiac surgery and there are no univocal guidelines in this sense. The aim of this survey was to investigate the actual clinical practice about ventilation techniques used in the Italian cardiac surgery centers. METHODS: A questionnaire of 32-item was sent to 69 Italian cardiac surgery centers, 56 of which return a completed form (81.2%). The questionnaire was assembled by three independent researchers and the final version was e-mailed to all members of the SIAARTI (Italian society of anesthesia resuscitation and intensive care medicine) Study Group on Cardiothoracic and Vascular Anesthesia. The answers were collected using a Google Forms sheet. In case of multiple questionnaires returned from the same center (i.e., different physicians from the same center responded) the head of department was asked to give a definite answer. Furthermore, for the 17 centers who reported multiple questionnaires, no large differences were found between the responses of different doctors belonging to the same center (12.3%±4.2% of discordant answers). RESULTS: Intraoperatively, patients were ventilated with a tidal volume (TV) of 6-8 mL/kg (91.1% of centers), a positive end-expiration pressure of 3-5 cmH2O (76.8% of centers) and a fraction of inspired oxygen (FiO2) of 50-80% (60.7% of centers). During the CPB, the "stop ventilation" technique was frequently adopted (73.2%). Before the discharge from the intensive care unit (ICU) non-invasive ventilation (NIV) was never applied in 32.1% of the centers, but it was used in 46.4% of patients with postoperative complications. CONCLUSIONS: This study shows a significant heterogeneity in ventilatory techniques among the Italian centers during CPB, whereas in the other surgical time the majority of the responding centers adopted a protective mechanical ventilation strategy.