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Randomized Controlled Trial
. 2011 May;114(5):1102-10.
doi: 10.1097/ALN.0b013e318215e254.

Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients

Sugantha Sundar  1 , Victor Novack, Karinne Jervis, S Patrick Bender, Adam Lerner, Peter Panzica, Feroze Mahmood, Atul Malhotra, Daniel Talmor
Affiliations
Randomized Controlled Trial

Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients

Sugantha Sundar et al. Anesthesiology. 2011 May.

Abstract

Background: Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation

Methods: A single-center randomized controlled trial was undertaken in 149 patients undergoing elective cardiac surgery. Ventilation with 6 versus 10 ml/kg tidal volume was compared. Ventilator settings were applied immediately after anesthesia induction and continued throughout surgery and the subsequent intensive care unit stay. The primary endpoint of the study was time to extubation. Secondary endpoints included the proportion of patients extubated at 6 h and indices of lung mechanics and gas exchange as well as patient clinical outcomes.

Results: Median ventilation time was not significantly different in the low tidal volume group; a median (interquartile range) of 450 (264-1,044) min was achieved compared with 643 (417-1,032) min in the control group (P = 0.10). However, a higher proportion of patients in the low tidal volume group was free of any ventilation at 6 h: 37.3% compared with 20.3% in the control group (P = 0.02). In addition, fewer patients in the low tidal volume group required reintubation (1.3 vs. 9.5%; P = 0.03).

Conclusions: Although reduction of tidal volume in mechanically ventilated patients undergoing elective cardiac surgery did not significantly shorten time to extubation, several improvements were observed in secondary outcomes. When these data are combined with a lack of observed complications, a strategy of reduced tidal volume could still be beneficial in this patient population.

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Figures

Fig. 1
Fig. 1
CONSORT (Consolidated Standards of Reporting Trials) diagram of study enrollment. Analysis was done on an intention-to-treat basis.
Fig. 2
Fig. 2
Oxygenation and ventilation parameters for intubated patients in the low tidal volume (TV) and control groups. Time is shown from intubation. Vertical bars represent SEM. CPB = cardiopulmonary bypass; ICU = intensive care unit.
Fig. 3
Fig. 3
Kaplan-Meier analysis of time to extubation. At 16 h, the curves describing time to extubation between the two study groups converge.
See this image and copyright information in PMC

Comment in

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