Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass

Chaney, Mark A.; Nikolov, Mihail P.; Blakeman, Bradford; Bakhos, Mamdouh

doi:10.1053/jcan.2000.9487

Cited by 75 publications

(63 citation statements)

References 26 publications

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“…Larger RCTs addressing this question are needed to provide data better applicable to clinical practice. Chaney et al 20 5.9 ± 3.9 10.8 ± 12.9 -0.50 (-1.31 to 0.32)…”

Section: Resultsmentioning

confidence: 96%

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Wang

Liu

2014

CMAJ

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Interpretation:Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. Implementation of a lung-protective ventilation strategy with lower tidal volumes may lower the incidence of these outcomes. Abstract Research E102CMAJ, February 17, 2015, 187(3)

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“…Larger RCTs addressing this question are needed to provide data better applicable to clinical practice. Chaney et al 20 5.9 ± 3.9 10.8 ± 12.9 -0.50 (-1.31 to 0.32)…”

Section: Resultsmentioning

confidence: 96%

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Wang

Liu

2014

CMAJ

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“…Th is positive eff ect on postoperative FRC could be related to the prevention of additional lung injury caused by mechanical ventilation. Chaney et al similarly reported better dynamic and static lung compliance and less shunt in patients ventilated with low compared to high V T (6 versus 12 ml/kg) [49].…”

Section: Cardiac Surgerymentioning

confidence: 90%

Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

Coppola¹,

Froio²,

Chiumello³

2014

Annual Update in Intensive Care and Emergency Medicine 2014

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IntroductionIn acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (V T ) and low levels of positive endexpiratory pressure (PEEP) can promote ventilatorinduced lung injury (VILI), thus increasing morbidity and mortality [1]. An open lung strategy, combining the use of low V T with adequate PEEP levels and recruitment maneuvers, has thus been recommended in ARDS patients [2]-[4]. In patients without ARDS admitted to intensive care units (ICUs), who required mechanical ventilation for at least 12 hours, the use of a high V T signifi cantly increased the infl ammatory response [5], [6]. In contrast to critically ill patients, during general anesthesia, mechanical ventilation is required only for a few hours, thus the benefi cial eff ects of lung-protective ventilation remain questionable. Moreover, there are limited data from few randomized controlled trials with only small cohorts of enrolled patients.Two recent meta-analyses that enrolled patients from ICUs and the operating room (OR) showed that lungprotective ventilation was associated with lower mortality and postoperative complications [2], [7]. However, there are no recommendations regarding optimal ventilatory strategies in patients without lung injury during general anesthesia.In the present article, we provide a comprehensive picture of the current literature on lung-protective ventilation during general anesthesia in patients without ARDS, focusing on the applications of this strategy in patients undergoing abdominal, thoracic and cardiac surgery. How mechanical ventilation is applied in the operating roomAlthough the protective ventilation approach may be benefi cial in a broader population with and without ARDS, the use of high V T without PEEP is still common during general anesthesia. A large French multicenter observational study, in which more than 2,900 patients undergoing general anesthesia were enrolled, showed that 18 % of patients were ventilated with a V T greater than 10 ml/kg body weight and 81 % without PEEP [8]. Moreover, a recruitment maneuver was applied in only 7 % of patients.Similarly a 5-year observational study, in which 45,575 patients were enrolled, reported that although use of a V T less than 10 ml/kg and PEEP levels greater than 5 cmH 2 O increased progressively over time, 16-18 % of patients continued to receive a V T greater than 10 ml/kg without application of PEEP [9]. Th e presence of obesity and a short height were the main risk factors for receiving a large V T during prolonged anesthesia [10]. Rationale for lung-protective ventilation during general anesthesiaGeneral anesthesia aff ects lung function primarily because of the loss of muscle tone, which promotes a reduction in lung volume, an alteration in ventilationperfusion ratio and the onset of lung atelectasis. Th e development of atelectasis is very common and occurs in more than 90 % of subjects undergoing general anesthesia [11], [12]. Atelectasis is mainly due to three basic mechanisms [13], ...

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“…A subsequent study of 25 patients undergoing coronary artery bypass grafting reported improved lung compliance when patients were randomly assigned to 6 ml/ kg tidal volume rather than 12 ml/kg. 9 Recently, Determann et al 20 reported the results of a larger randomized controlled trial. In that trial, 150 patient without ARDS/ALI were allocated to 6 versus 10 ml/kg tidal volume.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, despite biologic plausibility and considerable retrospective data to support limiting tidal volume in all ventilated patients, equipoise remains regarding optimal tidal volume in non-ALI patients. Although various groups of surgical patients, but especially cardiac surgical patients, have been observed, [8][9][10][11][12][13][14][15][16][17][18][19][20] these investigations have focused primarily on surrogate outcomes measures, leaving a lack of clarity regarding optimal perioperative ventilator strategy.…”

mentioning

confidence: 99%

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Sundar¹,

Novack²,

Jervis³

et al. 2011

Survey of Anesthesiology

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Background-Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation

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Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass

Cited by 75 publications

References 26 publications

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

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