Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study
Massimo A. Padalino,Luca Vedovelli,Manuela Simonato,A Bandini,Greta Paganini,Laura Mezzalira,Nicola Faganello,C. Carollo,Dario Gregori,Vladimiro L. Vida,Paola Cogo +10 more
TL;DR: Investigating if a ‘protective’ (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease undergoing repair with cardiopulmonary bypass found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time.
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Abstract: Abstract OBJECTIVES The aim of this study was to evaluate if a ‘protective’ (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB). METHODS This is a single-centre prospective, interventional study, including children with CHD under the age of 5 years, undergoing open-heart surgery with a CPB >60 min, in hypothermia, haemodynamically stable, and without evident genetic abnormalities. Assist-control ventilation (tidal volume of 4 ml/kg, 10 breaths/min, positive end-expiratory pressure 5 cmH2O and FiO2 0.21) was applied in a cohort of patients during CPB. We compared clinical outcomes and in fully ventilated versus non-ventilated (control) patients. Propensity score was used to weigh ventilated and control groups to correct for the effect of other confounding clinical variables. Clinical and ventilation parameters and lung inflammatory biomarkers in tracheal aspirates were measured. The primary outcome was the postoperative intubation time of more or less than 48 h. RESULTS We included 140 children (53 ventilated, 87 non-ventilated) with different CHD. There were no deaths or adverse events in ventilated patients. Using a weighted generalized linear model, we found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time [estimate 0.13 (95% confidence interval, –0.08; 0.35), P = 0.22]. CONCLUSIONS Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe and harmless. However, no significant advantages were found when compared to non-ventilated patients in terms of postoperative ventilation time.
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Citations
Effect of different ventilation strategies during cardiopulmonary bypass on cardiac de-airing in congenital cardiac surgery: A trans-esophageal echocardiography comparative study
TL;DR: In this paper , the authors evaluated the efficacy of using either low tidal ventilation or continuous positive pressure ventilation on the quality of de-airing procedure during cardiopulmonary bypass (CPB) surgery for correction of congenital heart diseases.
Evaluation of the effect of ventilation strategies during cardiopulmonary bypass on postoperative pulmonary complication in pediatric cardiac surgery
TL;DR: Maintaining ventilation during CPB can reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery, and the frequency of postoperative atelectasis was statistically insignificant between the studied groups.
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