Individualized Flow-controlled versus Pressure-controlled Ventilation in Cardiac Surgery: A Randomized Controlled...

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Respiratory Physiology

Background:

• On-pump cardiac surgery patients face high risks of perioperative lung injury and inflammation.
• Mechanical ventilation strategies aim to mitigate these risks.
• Flow-Controlled Ventilation (FCV) offers potential for reduced mechanical power compared to conventional Pressure-Controlled Ventilation (PCV).

Purpose of the Study:

• To investigate if FCV reduces the inflammatory stimulus compared to PCV in cardiac surgery patients.
• To evaluate the impact of FCV on perioperative lung injury and postoperative complications.

Main Methods:

• A single-center randomized controlled trial involving 140 adult patients undergoing cardiac surgery.
• Patients were allocated to either FCV or PCV with individualized positive end-expiratory pressure (PEEP) and driving pressure (ΔP).
• Primary endpoint: postoperative plasmatic interleukin 8 (IL-8) levels six hours after cardiopulmonary bypass.

Main Results:

• No significant difference in median postoperative IL-8 levels between FCV and PCV groups.
• FCV reduced perioperatively applied mechanical power by 55%.
• FCV group showed lower incidences of postoperative pulmonary and extrapulmonary complications, and shorter hospital stays.

Conclusions:

• FCV did not significantly reduce IL-8 levels at six hours post-cardiopulmonary bypass.
• The substantial reduction in mechanical power and positive trends in secondary outcomes support further investigation of FCV.