Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Nov;131(5):1046-1062.
doi: 10.1097/ALN.0000000000002909.

Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery

Michael R Mathis  1 , Neal M Duggal, Donald S Likosky, Jonathan W Haft, Nicholas J Douville, Michelle T Vaughn, Michael D Maile, Randal S Blank, Douglas A Colquhoun, Raymond J Strobel, Allison M Janda, Min Zhang, Sachin Kheterpal, Milo C Engoren
Affiliations
Observational Study

Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery

Michael R Mathis et al. Anesthesiology. 2019 Nov.

Erratum in

Abstract

Background: Compared with historic ventilation strategies, modern lung-protective ventilation includes lower tidal volumes (VT), lower driving pressures, and application of positive end-expiratory pressure (PEEP). The contributions of each component to an overall intraoperative protective ventilation strategy aimed at reducing postoperative pulmonary complications have neither been adequately resolved, nor comprehensively evaluated within an adult cardiac surgical population. The authors hypothesized that a bundled intraoperative protective ventilation strategy was independently associated with decreased odds of pulmonary complications after cardiac surgery.

Methods: In this observational cohort study, the authors reviewed nonemergent cardiac surgical procedures using cardiopulmonary bypass at a tertiary care academic medical center from 2006 to 2017. The authors tested associations between bundled or component intraoperative protective ventilation strategies (VT below 8 ml/kg ideal body weight, modified driving pressure [peak inspiratory pressure - PEEP] below 16 cm H2O, and PEEP greater than or equal to 5 cm H2O) and postoperative outcomes, adjusting for previously identified risk factors. The primary outcome was a composite pulmonary complication; secondary outcomes included individual pulmonary complications, postoperative mortality, as well as durations of mechanical ventilation, intensive care unit stay, and hospital stay.

Results: Among 4,694 cases reviewed, 513 (10.9%) experienced pulmonary complications. After adjustment, an intraoperative lung-protective ventilation bundle was associated with decreased pulmonary complications (adjusted odds ratio, 0.56; 95% CI, 0.42-0.75). Via a sensitivity analysis, modified driving pressure below 16 cm H2O was independently associated with decreased pulmonary complications (adjusted odds ratio, 0.51; 95% CI, 0.39-0.66), but VT below 8 ml/kg and PEEP greater than or equal to 5 cm H2O were not.

Conclusions: The authors identified an intraoperative lung-protective ventilation bundle as independently associated with pulmonary complications after cardiac surgery. The findings offer insight into components of protective ventilation associated with adverse outcomes and may serve as targets for future prospective interventional studies investigating the impact of specific protective ventilation strategies on postoperative outcomes after cardiac surgery.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors declare no competing interests beyond those described in the funding statement.

Figures

Fig. 1:
Fig. 1:
Study inclusion and exclusion criteria.
Fig. 2:
Fig. 2:
Frequency distributions of per-case median intraoperative ventilator parameters, including tidal volume per predicted body weight, modified driving pressure, and positive end-expiratory pressure (in left, middle, and right panels, respectively).
Fig. 3:
Fig. 3:
Temporal trends in intraoperative ventilator strategies, including tidal volume per predicted body weight, modified driving pressure, and positive end-expiratory pressure (in left, middle, and right panels, respectively).
Fig. 4:
Fig. 4:
Independent associations between intraoperative lung protective ventilation strategies and postoperative pulmonary complications.
Fig. 5:
Fig. 5:
Significant independent associations between multivariable model components and postoperative pulmonary complications.
See this image and copyright information in PMC

Comment in

References

    1. Zochios V, Klein AA, Gao F: Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2017 - PubMed
    1. Ibanez J, Riera M, Amezaga R, Herrero J, Colomar A, Campillo-Artero C, Ibarra JI de, Bonnin O: Long-Term Mortality After Pneumonia in Cardiac Surgery Patients: A Propensity-Matched Analysis. J Intensive Care Med 2016; 31:34–40 - PubMed
    1. Brown PP, Kugelmass AD, Cohen DJ, Reynolds MR, Culler SD, Dee AD, Simon AW: The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg 2008; 85:1980–6 - PubMed
    1. Garcia-Delgado M, Navarrete-Sanchez I, Colmenero M: Preventing and managing perioperative pulmonary complications following cardiac surgery. Curr Opin Anaesthesiol 2014; 27:146–52 - PubMed
    1. Lellouche F, Delorme M, Bussieres J, Ouattara A: Perioperative ventilatory strategies in cardiac surgery. Best Pract Res Clin Anaesthesiol 2015; 29:381–95 - PMC - PubMed

Publication types

MeSH terms