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Published on: May 26, 2023
Effect of Ventilation Strategy During Cardiopulmonary Bypass on Arterial Oxygenation and Postoperative Pulmonary
Ahmed Mohamed Elhaddad1, Mohamed Farouk Youssef1, Abdelhay Abdelgayed Ebad1
1Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt.
Objectives:
To compare the effects of 3 ventilation strategies during cardiopulmonary bypass (CPB) on arterial oxygenation and postoperative pulmonary complications (PPCs).
Design:
A prospective, randomized, controlled study.
Setting:
A single-center tertiary teaching hospital.
Participants:
One hundred twenty pediatric patients undergoing elective repair of congenital acyanotic heart diseases with CPB.
Interventions:
Patients were assigned randomly into 3 groups according to ventilation strategy during CPB as follows: (1) no mechanical ventilation (NOV), (2) continuous positive airway pressure (CPAP) of 5 cmH2O, (3) low tidal volume (LTV), pressure controlled ventilation (PCV), respiratory rate (RR) 20-to-30/min, and peak inspiratory pressure adjusted to keep tidal volume (Vt) 2 mL/kg.
Measurements And Main Results:
The PaO2/fraction of inspired oxygen (FIO2) ratio and PaO2 were higher in the 5 minutes postbypass period in the LTV group but were nonsignificant. The PaO2/FIO2 ratio and PaO2 were significant after chest closure and 1 hour after arrival to the intensive care unit with a higher PaO2/FIO2 ratio and PaO2 in the LTV group. Regarding the oxygenation index, the LTV group was superior to the NOV group at the 3 time points, with lower values in the LTV group. There were no significant differences in the predictive indices among the 3 groups, including the extubation time, and postoperative intensive care unit stays days. The incidence of PPCs did not significantly differ among the 3 groups.
Conclusions:
Maintaining ventilation during CPB was associated with better oxygenation and did not reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery.
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