Effect of driving pressure-guided lung protective ventilation strategy on early postoperative pulmonary function in adults patients undergoing heart valve surgery: A randomized controlled study
- VernacularTitle:驱动压导向肺保护性通气策略对成人心脏瓣膜手术术后早期肺功能影响的随机对照研究
- Author:
Rongjuan JIANG
1
,
2
,
3
;
Wenjie MAO
4
,
5
,
6
;
Hong YU
7
;
Xuefei LI
7
;
Mengqiu ZHANG
7
;
Hai YU
7
Author Information
1. . Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
2. 2. Department of Anesthesiology, Chengdu Second People&rsquo
3. s Hospital, Chengdu, 610017, P.R.China
4. 1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
5. 3. Department of Anesthesiology, Jianyang People&rsquo
6. s Hospital, Chengdu, 641400, P.R.China
7. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
- Publication Type:Journal Article
- Keywords:
Positive end-expiratory pressure;
oxygen index;
valve surgery;
lung protective ventilation strategy;
driving pressure;
randomized controlled study
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2021;28(06):663-669
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass. Methods In this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation. Results There was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01). Conclusion Application of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.
