Mechanical Ventilation During Cardiopulmonary Bypass

Bignami, Elena; Guarnieri, Marcello; Saglietti, Francesco; Belletti, Alessandro; Trumello, Cinzia; Giambuzzi, Ilaria; Monaco, Fabrizio; Alfieri, Ottavio

doi:10.1053/j.jvca.2016.03.015

Cited by 53 publications

(45 citation statements)

References 56 publications

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“…Bignami et al [2] reviewed the literature concerning CPB-related respiratory insufficiency and lung damage, concluding that correct ventilation during CPB, as a paramount part of multidisciplinary approach, might diminish the occurrence of postoperative lung injury. A meta-analysis reported by Schreiber et al [33] showed that CPAP or VCMs administrated during CPB had a potential trend for lung protection based on some surrogate endpoints but no sustained effect postoperatively was found.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that the potential mechanisms of CPB-related lung dysfunction involved pulmonary atelectasis, intrapulmonary shunt, and change of systemic immune and inflammatory status. [2] This meta-analysis examined the efficacy and safety of ventilation during CPB in patients who underwent elective cardiac surgery. It is not only an update of Schreiber et al's study but also provides different comparison direction and endpoints.…”

Section: Discussionmentioning

confidence: 99%

“…[2,5] As VCM is not a continuous ventilation type and has been recommended as a lung protective strategy in clinical practice at the weaning of CPB, VCM treatment alone was excluded and we mainly discuss CPAP or low TV ventilation during CPB. And owing to the endpoints of interest in the included studies were gathered at various time points, we chose the most frequent overlapped time point (immediately after CPB) to analyze the endpoints of patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] Various strategies including perioperative management of mechanical ventilation (MV), restrictive transfusion, technical modifications of CPB, and medication administration such as steroids and aprotinin have been developed to reduce impairment of pulmonary function. [3–5] Ventilation during CPB is an important element of MV management strategies and determined by anesthesiologists in the operation room.…”

Section: Introductionmentioning

confidence: 99%

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Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Chi

Chen²,

Shi³

et al. 2017

Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Chi

Chen²,

Shi³

et al. 2017

Medicine

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“…Pulmonary atelectasis is but one modifiable component of pulmonary dysfunction after CPB. Apnea during CPB has been suggested to promote the activation of lysosomal enzymes in the pulmonary circulation which in turn are correlated with the incidence of postoperative pulmonary dysfunction [43–46]. CPB duration has also been associated with lung injury and mortality.…”

Section: Discussionmentioning

confidence: 99%

Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

Bignami

Guarnieri

Saglietti

et al. 2017

Trials

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BackgroundThere is no consensus on which lung-protective strategies should be used in cardiac surgery patients. Sparse and small randomized clinical and animal trials suggest that maintaining mechanical ventilation during cardiopulmonary bypass is protective on the lungs. Unfortunately, such evidence is weak as it comes from surrogate and minor clinical endpoints mainly limited to elective coronary surgery. According to the available data in the academic literature, an unquestionable standardized strategy of lung protection during cardiopulmonary bypass cannot be recommended. The purpose of the CPBVENT study is to investigate the effectiveness of different strategies of mechanical ventilation during cardiopulmonary bypass on postoperative pulmonary function and complications.Methods/designThe CPBVENT study is a single-blind, multicenter, randomized controlled trial. We are going to enroll 870 patients undergoing elective cardiac surgery with planned use of cardiopulmonary bypass. Patients will be randomized into three groups: (1) no mechanical ventilation during cardiopulmonary bypass, (2) continuous positive airway pressure of 5 cmH2O during cardiopulmonary bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2–3 ml/Kg of ideal body weight and positive end-expiratory pressure of 3–5 cmH2O during cardiopulmonary bypass. The primary endpoint will be the incidence of a PaO2/FiO2 ratio <200 until the time of discharge from the intensive care unit. The secondary endpoints will be the incidence of postoperative pulmonary complications and 30-day mortality. Patients will be followed-up for 12 months after the date of randomization.DiscussionThe CPBVENT trial will establish whether, and how, different ventilator strategies during cardiopulmonary bypass will have an impact on postoperative pulmonary complications and outcomes of patients undergoing cardiac surgery.Trial registrationClinicalTrials.gov, ID: NCT02090205. Registered on 8 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2008-2) contains supplementary material, which is available to authorized users.

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Factors influencing the use of postoperative bilevel positive airway pressure (BiPAP) in patients undergoing adult cardiac surgery: A retrospective cohort study

Ahmed

Yousuf

Samad

et al. 2022

Health Science Reports

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BAckground and Aims Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery. Methods It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the final analysis. Data of 260 patients were analyzed for compiling of results. Results The mean age was 59 years. 196 (75.4%) patients were males and females were 64 (24.6%). Mean weight was 72 kg and mean body mass index (BMI) 26.67 kg/m 2 . BiPAP application was in 38 (14.6%) patients and significantly high in with high BMI, ( p < 0.05). There are significant associations of BiPAP application patients with COPD ( p < 0.05). Patients with positive fluid balance, cardiac dysfunction, and required inotropic support were significantly associated with BiPAP need ( p < 0.05), respectively. Conclusion BiPAP is effective to treat ARF and other respiratory complications after adult cardiac surgeries. High BMI, atelectasis, and pneumonia are also the independent factors causing ARF. BiPAP can be a successful tool for preventing the adverse effects of postoperative pulmonary complications after cardiac surgery.

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Mechanical Ventilation During Cardiopulmonary Bypass

Cited by 53 publications

References 56 publications

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

Factors influencing the use of postoperative bilevel positive airway pressure (BiPAP) in patients undergoing adult cardiac surgery: A retrospective cohort study

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