Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MAO Wenjie ^1,2 , JIANG Rongjuan ^1,3 , YU Hong ¹ , ZHANG Mengqiu ¹ ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Anesthesiology, Jianyang People’s Hospital, Chengdu, 641400, P. R. China;
3. Department of Anesthesiology, Chengdu Second People’s Hospital, Chengdu, 610017, P. R. China;

Corresponding?author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Pressure-controlled ventilation-volume guarantee; pressure-controlled ventilation; volume-controlled ventilation; cardiac surgery; postoperative pulmonary complications

DOI：

10.7507/1007-4848.202104045

Video：

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Objective To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB).Methods The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Citation： MAO Wenjie, JIANG Rongjuan, YU Hong, ZHANG Mengqiu, YU Hai. Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 356-365. doi: 10.7507/1007-4848.202104045 Copy

1.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
2.	Iba?ez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
3.	Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: International expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
4.	Chiarenza F, Tsoutsouras T, Cassisi C, et al. The effects of on-pump and off-pump coronary artery bypass surgery on respiratory function in the early postoperative period. J Intensive Care Med, 2019, 34(2): 126-132.
5.	Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of intensive vs. moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications: A randomized clinical trial. JAMA, 2017, 317(14): 1422-1432.
6.	Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
7.	Weiss YG, Merin G, Koganov E, et al. Postcardiopulmonary bypass hypoxemia: A prospective study on incidence, risk factors, and clinical significance. J Cardiothorac Vasc Anesth, 2000, 14(5): 506-513.
8.	Li C, Yang WH, Zhou J, et al. Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: Results from a single vascular center in China. J Clin Anesth, 2013, 25(5): 371-378.
9.	Ball L, Costantino F, Orefice G, et al. Intraoperative mechanical ventilation: State of the art. Minerva Anestesiol, 2017, 83(10): 1075-1088.
10.	Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: A systematic review and individual patient data meta-analysis. Anesthesiology, 2015, 123(1): 66-78.
11.	Wang C, Zhao N, Wang W, et al. Intraoperative mechanical ventilation strategies for obese patients: A systematic review and network meta-analysis. Obes Rev, 2015, 16(6): 508-517.
12.	Jiang J, Li B, Kang N, et al. Pressure-controlled versus volume-controlled ventilation for surgical patients: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(2): 501-514.
13.	Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
14.	Abbott TEF, Fowler AJ, Pelosi P, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: Pulmonary complications. Br J Anaesth, 2018, 120(5): 1066-1079.
15.	O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
16.	Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
17.	Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol, 2004, 159(7): 702-706.
18.	von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
19.	Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
20.	Bristle TJ, Collins S, Hewer I, et al. Anesthesia and critical care ventilator modes: Past, present, and future. AANA J, 2014, 82(5): 387-400.
21.	Bagchi A, Rudolph MI, Ng PY, et al. The association of postoperative pulmonary complications in 109, 360 patients with pressure-controlled or volume-controlled ventilation. Anaesthesia, 2017, 72(11): 1334-1343.
22.	Aoyama H, Pettenuzzo T, Aoyama K, et al. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2018, 46(2): 300-306.
23.	Neto AS, Hemmes SN, Barbas CS, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data. Lancet Respir Med, 2016, 4(4): 272-280.
24.	Dreyfuss D, Saumon G. Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis, 1993, 148(5): 1194-1203.
25.	Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med, 2010, 181(6): 578-586.
26.	Ho?ten T, Ku? A, Gümü? E, et al. Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery. J Clin Monit Comput, 2017, 31(1): 75-84.
27.	Ugurlucan M, Basaran M, Erdim F, et al. Pressure-controlled mechanical ventilation is more advantageous in the follow-up of patients with chronic obstructive pulmonary disease after open heart surgery. Heart Surg Forum, 2014, 17(1): E1-E6.

1. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
2. Iba?ez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
3. Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: International expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
4. Chiarenza F, Tsoutsouras T, Cassisi C, et al. The effects of on-pump and off-pump coronary artery bypass surgery on respiratory function in the early postoperative period. J Intensive Care Med, 2019, 34(2): 126-132.
5. Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of intensive vs. moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications: A randomized clinical trial. JAMA, 2017, 317(14): 1422-1432.
6. Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
7. Weiss YG, Merin G, Koganov E, et al. Postcardiopulmonary bypass hypoxemia: A prospective study on incidence, risk factors, and clinical significance. J Cardiothorac Vasc Anesth, 2000, 14(5): 506-513.
8. Li C, Yang WH, Zhou J, et al. Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: Results from a single vascular center in China. J Clin Anesth, 2013, 25(5): 371-378.
9. Ball L, Costantino F, Orefice G, et al. Intraoperative mechanical ventilation: State of the art. Minerva Anestesiol, 2017, 83(10): 1075-1088.
10. Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: A systematic review and individual patient data meta-analysis. Anesthesiology, 2015, 123(1): 66-78.
11. Wang C, Zhao N, Wang W, et al. Intraoperative mechanical ventilation strategies for obese patients: A systematic review and network meta-analysis. Obes Rev, 2015, 16(6): 508-517.
12. Jiang J, Li B, Kang N, et al. Pressure-controlled versus volume-controlled ventilation for surgical patients: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(2): 501-514.
13. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
14. Abbott TEF, Fowler AJ, Pelosi P, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: Pulmonary complications. Br J Anaesth, 2018, 120(5): 1066-1079.
15. O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
16. Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
17. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol, 2004, 159(7): 702-706.
18. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
19. Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
20. Bristle TJ, Collins S, Hewer I, et al. Anesthesia and critical care ventilator modes: Past, present, and future. AANA J, 2014, 82(5): 387-400.
21. Bagchi A, Rudolph MI, Ng PY, et al. The association of postoperative pulmonary complications in 109, 360 patients with pressure-controlled or volume-controlled ventilation. Anaesthesia, 2017, 72(11): 1334-1343.
22. Aoyama H, Pettenuzzo T, Aoyama K, et al. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2018, 46(2): 300-306.
23. Neto AS, Hemmes SN, Barbas CS, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data. Lancet Respir Med, 2016, 4(4): 272-280.
24. Dreyfuss D, Saumon G. Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis, 1993, 148(5): 1194-1203.
25. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med, 2010, 181(6): 578-586.
26. Ho?ten T, Ku? A, Gümü? E, et al. Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery. J Clin Monit Comput, 2017, 31(1): 75-84.
27. Ugurlucan M, Basaran M, Erdim F, et al. Pressure-controlled mechanical ventilation is more advantageous in the follow-up of patients with chronic obstructive pulmonary disease after open heart surgery. Heart Surg Forum, 2014, 17(1): E1-E6.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study

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