Mechanical ventilation management during cardiothoracic surgery: an open challenge.

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Cardiothoracic surgery necessitates complex mechanical ventilation with significant hemodynamic challenges.
• High rates of postoperative pulmonary complications (PPC), comorbidity, and mortality are associated with these procedures.
• Lung injury during surgery stems from factors like cardiopulmonary bypass, sternotomy, lung overdistention, and permissive hyperoxia.

Purpose of the Study:

• To review current understanding and emerging strategies for mechanical ventilation in cardiothoracic surgery.
• To address the lack of consensus on best practices for lung-protective ventilation in this patient population.
• To highlight recent progress and positive clinical outcomes in protective ventilation techniques.

Main Methods:

• Review of recent clinical trials and literature on mechanical ventilation techniques in cardiothoracic surgery.
• Analysis of the interplay between circulatory and pulmonary systems during surgical procedures.
• Evaluation of stress-induced lung injury mechanisms in cardiac and thoracic surgery.

Main Results:

• Protective ventilation strategies aim to mitigate stress-induced lung damage.
• Despite challenges, recent advancements show positive clinical outcomes in lung protection.
• No clear international guidelines for mechanical ventilation in cardiothoracic surgery exist yet.

Conclusions:

• Mechanical ventilation in cardiothoracic surgery is complex, balancing hemodynamic stability and lung protection.
• Protective ventilation strategies are increasingly recognized for their potential to reduce postoperative pulmonary complications.
• Further research and guideline development are needed to optimize mechanical ventilation practices in cardiothoracic surgery.