Effects of Positive Airway Pressure and Mechanical Ventilation of the Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After Cardiac Surgery: A Systematic Review and Meta-Analysis

Mechanical ventilation and cardiopulmonary bypass: a narrative review of the mechanistic lung protective measures

“…Thirty-five (n = 35) articles were excluded due to no CPB surgery or intraoperative ventilation was discussed (n = 27), case reports (n = 2), protocol design (n = 2), trials involving cardiac surgeries in children (n = 1), thesis (n = 1), and no full-text available (n = 2). Therefore, 13 articles were included for further description in our qualitative analysis: systematic review and meta-analysis (n = 1) [2] , meta-analysis (n = 1) [8] , randomized clinical trials or RCTs (n = 3) [9][10][11] , prospective observational (n = 1) [12] , and reviews (n = 7) [4][5][6][13][14][15][16] . Figure 1 describes the flow diagram corresponding to our search.…”

“…Subsequently, only 5 studies (134 patients in total) reported the use of CPAP during CPB and its impact on oxygenation. Other primary end-points were PaO 2 /FiO 2 ratio (5 studies), the alveolar-arterial O 2 gradient or P(A-a)O 2 (9 studies), hospital LOS (6 studies), and the duration of postoperative MV (6 studies) [2] .…”

“…Wang et al [2] 2018 Systematic Review and Meta-analysis NA Different strategies used for mechanical ventilation during CPB and postoperative outcomes CPAP between 5-15 cm H 2 O during CPB may be associated with short-term benefits such as improved gas exchange and oxygenation. However, no significant differences in these variables were found when comparing patients undergoing mechanical ventilation during CPB and those non-ventilated CPB: cardiopulmonary bypass; RCT: randomized clinical trial; CCL: chemokine ligand; POD: postoperative day; CPAP: continuous positive airway pressure; VT: tidal volume; TNF-α: tumor necrosis factor alpha; IL: interleukin; ICU: intensive care unit; LOS: length of stay; IBW: ideal body weight; PEEP: positive end-expiratory pressure; FiO2: inspired fraction of oxygen; PPCs: postoperative pulmonary complications; CABG: coronary artery bypass graft; ARDS: acute respiratory distress syndrome…”

“…Impaired postoperative pulmonary function is a common and multifactorial complication after cardiac surgery [1,2] . Exacerbated cellular and humoral activation is a widely-known response ensuing from cardiopulmonary bypass (CPB), being the major cause of postoperative lung injury [3,4] .…”

“…Exacerbated cellular and humoral activation is a widely-known response ensuing from cardiopulmonary bypass (CPB), being the major cause of postoperative lung injury [3,4] . Protective mechanical ventilation (PMV) strategies such as the use of continuous positive airway pressure (CPAP) have shown benefits in non-cardiac surgeries [2] . Likewise, CPAP, low tidal volume (V T ) and recruitment maneuvers have been used in patients undergoing cardiac surgeries under CPB aiming to ameliorate lung mechanics and to decrease postoperative pulmonary complications (PPCs) [5,6] .…”