Impact of zero-positive end-expiratory pressure on blood transfusion rates in off-pump coronary artery bypass surgery: a retrospective cohort study.

Autor: Tarao K; Department of Anesthesiology, Chiba University Hospital, Chiba, Japan., Son K; Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260-8670, Japan. adya5599@chiba-u.jp., Ishizuka Y; Department of Anesthesiology, Chiba University Hospital, Chiba, Japan., Nakagomi A; Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.; Department of Cardiovascular Medicine, Chiba University Hospital, Chiba, Japan., Hasegawa-Moriyama M; Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260-8670, Japan.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2024 Dec 19; Vol. 24 (1), pp. 461. Date of Electronic Publication: 2024 Dec 19.
DOI: 10.1186/s12871-024-02853-7
Abstrakt: Background: Bleeding are common in cardiac surgery, with significant impacts on transfusion-related complications and patient prognosis. This study aimed to determine the differences in perioperative blood loss, transfusion rates, and the incidence of postoperative pulmonary complications (PPCs) with and without the use of positive end-expiratory pressure (PEEP) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).
Methods: This single-center, retrospective study included 106 adult patients undergoing coronary artery bypass surgery without cardiopulmonary bypass from January 2018 to March 2022. The patients were divided into two groups based on intraoperative ventilator settings: the zero-PEEP (ZEEP) group and the PEEP group. The primary outcome was the perioperative transfusion rate from the intraoperative period to postoperative 7 day. The incidence of PPCs was recorded for 1 week post-operatively. Logistic regression analysis was performed for statistical analysis.
Results: The average PEEP in the PEEP group was 4.92 ± 0.42 cmH 2 O. Multiple regression analysis indicated that lower mean airway pressure during surgery tend to associate with intraoperative lower blood loss. The intraoperative transfusion rates in the ZEEP group were significantly lower than those in the PEEP group (ZEEP:14%, PEEP 38.4%, P = 0.02). Logistic regression analysis revealed that ZEEP (adjusted odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04-0.78) and Society of Thoracic Surgeons(STS) scores (adjusted OR 2.31, 95% CI 1.53-3.49) were significantly associated with a reduced requirement for perioperative transfusions. No significant difference was observed between the two groups in terms of PPCs (p = 0.824). Atelectasis was the most common complication in both groups (ZEEP: 35.7%, PEEP: 40%, P = 0.832).
Conclusions: ZEEP and STS scores were associated with significantly reduced requirement for perioperative transfusion rates during elective OPCAB surgery. However, ZEEP did not significantly affect the incidence of PPCs.
Competing Interests: Declarations. Ethics approval and consent to participate: The Institutional Review Board (Research Ethics Committee of the Graduate School of Medicine, Chiba University) approved the study protocol (#M10313) and waived the requirement for individual informed consent due to the retrospective nature of the study. Instead, an opt-out approach was implemented, with study details and the option to decline participation disclosed on the hospital’s website. This ensured patient autonomy and compliance with ethical guidelines for retrospective studies. The study was conducted in accordance with the Clinical Trials Act of Japan and the Declaration of Helsinki. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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