Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): a protocol for a randomized controlled trial

Area of Science:

• Anesthesiology
• Cardiothoracic Surgery
• Pulmonary Medicine

Background:

• Cardiac surgery with cardiopulmonary bypass increases the risk of postoperative pulmonary complications, contributing to morbidity and mortality.
• Pulmonary ischemia-reperfusion (IR) injury during cardiopulmonary bypass is a significant factor in perioperative lung injury.
• Volatile anesthetics like sevoflurane show potential in mitigating IR-induced lung inflammation, but this needs validation in cardiac surgery patients.

Purpose of the Study:

• To evaluate if sevoflurane anesthetic maintenance can modulate pulmonary inflammation during cardiac surgery with cardiopulmonary bypass.
• To determine if sevoflurane reduces postoperative pulmonary complications in this patient population.

Main Methods:

• The Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS) trial is a prospective randomized controlled trial (RCT).
• Adult cardiac surgical patients were randomized to receive sevoflurane or propofol for intraoperative anesthetic maintenance.
• Lung inflammation was assessed by bronchoalveolar lavage (BAL) concentrations of TNFα post-reperfusion; secondary outcomes included other inflammatory markers and pulmonary complications.

Main Results:

• Primary outcome: difference in post-bypass lung inflammation (BAL TNFα concentrations) between sevoflurane and propofol groups.
• Secondary outcomes: differences in systemic inflammatory markers and incidence of postoperative pulmonary complications.

Conclusions:

• The APLICS trial assesses the impact of anesthetic choice on lung inflammation and outcomes following cardiac surgery.
• Positive findings would support the lung-protective effects of volatile anesthetics, potentially reducing patient morbidity.