Effect of Ventilation Strategy During Cardiopulmonary Bypass on Arterial Oxygenation and Postoperative Pulmonary Complications After Pediatric Cardiac Surgery: A Randomized Controlled Study.

Autor: Elhaddad AM; Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt. Electronic address: drblacksmith5@kasralainy.edu.eg., Youssef MF; Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt., Ebad AA; Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt., Abdelsalam MS; Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt., Kamel MM; Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2022 Dec; Vol. 36 (12), pp. 4357-4363. Date of Electronic Publication: 2022 Aug 31.
DOI: 10.1053/j.jvca.2022.08.023
Abstrakt: Objectives: To compare the effects of 3 ventilation strategies during cardiopulmonary bypass (CPB) on arterial oxygenation and postoperative pulmonary complications (PPCs).
Design: A prospective, randomized, controlled study.
Setting: A single-center tertiary teaching hospital.
Participants: One hundred twenty pediatric patients undergoing elective repair of congenital acyanotic heart diseases with CPB.
Interventions: Patients were assigned randomly into 3 groups according to ventilation strategy during CPB as follows: (1) no mechanical ventilation (NOV), (2) continuous positive airway pressure (CPAP) of 5 cmH 2 O, (3) low tidal volume (LTV), pressure controlled ventilation (PCV), respiratory rate (RR) 20-to-30/min, and peak inspiratory pressure adjusted to keep tidal volume (Vt) 2 mL/kg.
Measurements and Main Results: The PaO 2 /fraction of inspired oxygen (F I O 2 ) ratio and PaO 2 were higher in the 5 minutes postbypass period in the LTV group but were nonsignificant. The PaO 2 /F I O 2 ratio and PaO 2 were significant after chest closure and 1 hour after arrival to the intensive care unit with a higher PaO 2 /F I O 2 ratio and PaO 2 in the LTV group. Regarding the oxygenation index, the LTV group was superior to the NOV group at the 3 time points, with lower values in the LTV group. There were no significant differences in the predictive indices among the 3 groups, including the extubation time, and postoperative intensive care unit stays days. The incidence of PPCs did not significantly differ among the 3 groups.
Conclusions: Maintaining ventilation during CPB was associated with better oxygenation and did not reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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