Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for...

Area of Science:

• Pediatric Cardiac Surgery
• Critical Care Medicine
• Respiratory Physiology

Background:

• Children with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) often experience prolonged mechanical ventilation.
• Acute lung injury is a significant concern in this patient population post-surgery.
• Optimizing ventilation strategies during CPB is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the efficacy of a 'protective' ventilation strategy (low tidal volume, low frequency) during CPB in children with CHD.
• To determine if this strategy can shorten postoperative ventilation duration and minimize lung injury.
• To evaluate the safety and clinical impact of intraoperative mechanical ventilation in this cohort.

Main Methods:

• A single-centre prospective interventional study involving children under 5 years with CHD undergoing open-heart surgery with CPB.
• Assist-control ventilation with specific parameters (4 ml/kg tidal volume, 10 breaths/min) was applied to a cohort during CPB.
• Propensity score weighting was used to compare outcomes between ventilated and non-ventilated (control) groups, measuring clinical parameters and inflammatory biomarkers.

Main Results:

• 140 children were included (53 ventilated, 87 non-ventilated) with various CHDs.
• No deaths or adverse events were reported in the ventilated group.
• No significant evidence was found for an effect of intraoperative ventilation on postoperative intubation time (P=0.22).

Conclusions:

• Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe for children with CHD.
• This ventilation strategy did not demonstrate significant advantages over non-ventilation regarding postoperative ventilation time.
• Further research may be needed to explore alternative ventilation strategies or patient subgroups.