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Lung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: A
Yuan Sun1, Sai-E Shen1, Xiao-Ming Deng2
1Department of Anesthesiology and Critical Care Medicine, Xin Hua Hospital affiliated to Jiaotong University School of Medicine, Shanghai, China.
Insights
Lung protective ventilation (LPV) improved oxygenation and lung mechanics in infants undergoing cardiac surgery. While safe and effective, its benefits on long-term outcomes and pulmonary complications were limited.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiothoracic Surgery
- Respiratory Physiology
Background:
- Lung protective ventilation (LPV) is established for adults but understudied in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- Optimizing mechanical ventilation strategies is crucial for reducing postoperative pulmonary complications in this vulnerable population.
Purpose of the Study:
- To evaluate the safety and effectiveness of LPV in infants undergoing CPB for congenital heart disease (CHD).
- To compare LPV with conventional ventilation (CV) in terms of respiratory parameters and outcomes.
Main Methods:
- A randomized controlled trial involving 77 infants undergoing CPB for CHD.
- The LPV group received small tidal volumes (6-8 ml/kg), lung recruitment maneuvers, and individualized PEEP.
- The CV group received traditional tidal volumes (10-12 ml/kg) with zero PEEP.
Main Results:
- The LPV group showed significantly higher PaO2/FiO2 ratios post-intervention compared to the CV group (P < .001).
- Significant differences in dynamic compliance, alveolar-arterial oxygen difference, and driving pressure were observed between groups.
- No significant differences were found in long-term oxygenation, compliance, or postoperative pulmonary complications at 2 hours post-operation.
Conclusions:
- LPV is safe and improves oxygenation, alveolar aeration, and dynamic compliance in infants undergoing CPB.
- LPV reduces driving pressure, pulmonary shunting, and dead space.
- The beneficial effects of LPV on oxygenation and compliance were transient, with limited impact on postoperative complications and prognosis.
Background:
Lung protective ventilation (LPV) has been applied to surgical adults with normal pulmonary function for optimizing mechanical ventilation and reducing postoperative pulmonary complications. Few studies have reported the use of LPV in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Aims:
To explore safety and effectiveness of LPV in infants undergoing CPB surgery for congenital heart disease (CHD).
Methods:
Included in this study were 77 infants who underwent CPB surgery for CHD from November 2017 to September 2018. They were randomized into the LPV group and conventional ventilation (CV) group. In the LPV group, small-tidal-volume (6-8 ml/kg) ventilation, lung recruitment by PEEP increment to the maximum level of 15 cm H2 O after CPB, and individualized optimal PEEP titration were applied. In the CV group, traditional tidal volume (10-12 ml/kg with zero PEEP) was applied. The primary outcome was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction (PaO2 /FiO2 ). The secondary outcomes were respiratory dynamic parameters, hypoxemia, prognostic indexes, and postoperative pulmonary complications.
Results:
PaO2 /FiO2 in the LPV group (416.86, 95%CI: 381.60-452.12) was significantly higher than that in the CV group (263.37, 95%CI: 227.65-299.09) after intervention (P < .001). There was a significant difference in the trend of change in dynamic compliance, alveolar-arterial oxygen difference, arterial-end-expired carbon dioxide difference, driving pressure, and respiratory index between the two groups at different time points from weaning from CPB to 2 hours after operation. There was no significant difference in PaO2 /FiO2 , alveolar-arterial oxygen difference, respiratory index, and dynamic compliance 2 hours postoperative and in the incidence of postoperative pulmonary complications, prognostic indexes between the two groups.
Conclusions:
LPV could be used safely in infants undergoing CPB in that it can improve oxygenation, alveolar aeration, and dynamic compliance, and reduce driving pressure, pulmonary shunting, and dead space. Its effect on oxygenation, pulmonary gas exchange, and pulmonary compliance was relatively short, and had less impact on postoperative pulmonary complications and prognosis.
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