Ventilation strategies with different inhaled Oxygen conceNTration during CardioPulmonary Bypass in cardiac surgery (VONTCPB): study protocol for a randomized controlled trial

Zhang, Meng‐Qiu; Liao, Yu-Qi; Yu, Hong; Li, Xuefei; Feng, Lei; Yang, Xiaoyun; Yu, Hai

doi:10.1186/s13063-019-3335-2

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…After the procedure, this inflammatory response exacerbates with reperfusion, and the oxygen radicals produced trigger lung damage and create ground for postoperative complications. Atelectasis and interstitial fluid collection during the re-ventilation of lungs produce a ventilation-perfusion mismatch, further aggravating this process [ 2 , 6 ] . It is suggested that maintaining lung ventilation may be beneficial in preventing these mechanisms that develop during CPB.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

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Göz

2022

Braz J Cardiovasc Surg

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Introduction Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. Methods Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. Results C5a, IL-6, IL-8 and TNF-α were similar when compared to the low tidal volume ventilated and non-ventilated groups ( P >0.05) Comparing the groups by variables, IL-6 levels were increased during CPB in both groups ( P =0.021 and P =0.001), and IL-8 levels decreased in the ventilation group during CPB ( P =0.018). Conclusion Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

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Section: Discussionmentioning

confidence: 99%

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

Kankılıç

Aydın

Göz

2022

Braz J Cardiovasc Surg

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“…Обсуждение В настоящее время в мировой научной литературе возрос интерес к изучению функции легких при кардиохирургической патологии [9][10][11]. Многочисленными исследованиями показано, что состояние оксигенирующей функции легких до и во время хирургического вмешательства оказывает значимое влияние на клинический исход в раннем и отдаленном периодах наблюдения, что определяет целесообразность оценки исходной функции дыхания [12].…”

Section: Discussionunclassified

Carbon dioxide elimination pattern in assessing the risk of an unfavorable outcome in cardiac surgery

et al. 2020

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Aim. To assess the influence of resting partial pressure of end-tidal carbon dioxide (PetCO2) levels on the long-term results of cardiac surgery.Materials and methods. This prospective cohort study included 454 patients with coronary artery disease who underwent elective coronary artery bypass graft surgery. Before surgery, all patients underwent pulmonary function tests, including body plethysmography, lung diffusion capacity assessment and cardiopulmonary exercise testing with the determination of ventilatory and gas exchange parameters, including PetCO2 at rest. The endpoint was the 2-year survival rate after surgery.Results. Parameters characterizing the obstructive breathing pattern, the lung diffusion capacity, and resting PetCO2 levels had a significant predictor value in relation to long-term survival after cardiac surgery. Among the baseline clinical and functional characteristics, a significant influence on long-term results was shown by the EuroSCORE II (OR 1,69 (1,26-2,27), p=0,001). The highest sensitivity and specificity in relation to long-term mortality risk after coronary artery bypass grafting was shown by resting PetCO2 value equal to 31 mm Hg (area under the ROC curve 0,74 (0,64-0,86), p<0,001).Conclusion. The resting PetCO2 level below 31 mm Hg in patients with coronary artery disease showed a significant effect on the increased long-term mortality risk after cardiac surgery, which is important for patients with exercise intolerance.

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“…According to the application of average intraoperative PEEP values, the included patients were divided into high PEEP group (PEEP ≥5 cmH 2 O) and low PEEP group (PEEP <5 cmH 2 O, including PEEP=0 cmH 2 O). The primary outcome was the incidence of a composite of PPCs (respiratory failure, pulmonary infection, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis) (online supplemental table S1) within the first 7 postoperative days 21 22. The secondary outcomes included the incidence of reintubation and unplanned ICU admission within the first 7 postoperative days, as well as total hospital stay (day).…”

Section: Methodsmentioning

confidence: 99%

Positive end-expiratory pressure and risk of postoperative pulmonary complications in patients living at high altitudes and undergoing surgery at low altitudes: a single-centre, retrospective observational study in China

et al. 2022

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ObjectivesTo examine whether a high positive end-expiratory pressure (PEEP ≥5 cmH2O) has a protective effect on the risk of postoperative pulmonary complications (PPCs) in a cohort of patients living at high altitudes and undergoing general anaesthesia.DesignRetrospective, observational study.SettingA tertiary hospital in China.ParticipantsAdult Tibetan patients living at high altitudes (≥3000 m) and who went to the low-altitude plain to undergo non-cardiothoracic surgery under general anaesthesia, from January 2018 to April 2020.MeasurementsThis study included 1905 patients who were divided according to the application of an intraoperative PEEP: low PEEP (<5 cmH2O, including 0 cmH2O) or high PEEP (≥5 cmH2O). The primary outcome was a composite of PPCs within the first 7 postoperative days. The secondary outcomes included reintubation and unplanned intensive care unit (ICU) admission within the first 7 postoperative days and total hospital stays (day).ResultsThe study included 1032 patients in the low PEEP group and 873 in the high PEEP group. There were no differences in the incidence of PPCs between the high and low PEEP groups (relative risk (RR) 0.913; 95% CI 0.716 to 1.165; p=0.465). After propensity score matching, 643 patients remained in each group, and the incidence of PPCs in the low PEEP group (18.0%) was higher than in the high PEEP group (13.7%; RR 0.720; 95% CI 0.533 to 0.974; p=0.033). There were no differences in the incidence of reintubation, unplanned ICU admission or hospital stays. The risk factors of PPCs derived from multiple regression showed that the application of >5 cmH2O PEEP during intraoperative mechanical ventilation was associated with a significantly lower risk of PPCs in patients from a high altitude (OR=0.725, 95% CI 0.530 to 0.992; p=0.044).ConclusionsThe application of PEEP ≥5 cmH2O during intraoperative mechanical ventilation in patients living at high altitudes and undergoing surgery at low altitudes may be associated with a lower risk of PPCs. Prospective longitudinal studies are needed to further investigate perioperative lung protection ventilation strategies for patients from high altitudes.Trial registration numberChinese Clinical Trial Registry (ChiCTR2100044260).

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Ventilation strategies with different inhaled Oxygen conceNTration during CardioPulmonary Bypass in cardiac surgery (VONTCPB): study protocol for a randomized controlled trial

Cited by 11 publications

References 38 publications

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

Carbon dioxide elimination pattern in assessing the risk of an unfavorable outcome in cardiac surgery

Positive end-expiratory pressure and risk of postoperative pulmonary complications in patients living at high altitudes and undergoing surgery at low altitudes: a single-centre, retrospective observational study in China

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