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. 2024 Dec 19;24(1):461.
doi: 10.1186/s12871-024-02853-7.

Impact of zero-positive end-expiratory pressure on blood transfusion rates in off-pump coronary artery bypass surgery: a retrospective cohort study

Kentaroh Tarao  1 , Kyongsuk Son  2 , Yusei Ishizuka  1 , Atsushi Nakagomi  3   4 , Maiko Hasegawa-Moriyama  5
Affiliations

Impact of zero-positive end-expiratory pressure on blood transfusion rates in off-pump coronary artery bypass surgery: a retrospective cohort study

Kentaroh Tarao et al. BMC Anesthesiol. .

Abstract

Background: Bleeding are common in cardiac surgery, with significant impacts on transfusion-related complications and patient prognosis. This study aimed to determine the differences in perioperative blood loss, transfusion rates, and the incidence of postoperative pulmonary complications (PPCs) with and without the use of positive end-expiratory pressure (PEEP) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).

Methods: This single-center, retrospective study included 106 adult patients undergoing coronary artery bypass surgery without cardiopulmonary bypass from January 2018 to March 2022. The patients were divided into two groups based on intraoperative ventilator settings: the zero-PEEP (ZEEP) group and the PEEP group. The primary outcome was the perioperative transfusion rate from the intraoperative period to postoperative 7 day. The incidence of PPCs was recorded for 1 week post-operatively. Logistic regression analysis was performed for statistical analysis.

Results: The average PEEP in the PEEP group was 4.92 ± 0.42 cmH2O. Multiple regression analysis indicated that lower mean airway pressure during surgery tend to associate with intraoperative lower blood loss. The intraoperative transfusion rates in the ZEEP group were significantly lower than those in the PEEP group (ZEEP:14%, PEEP 38.4%, P = 0.02). Logistic regression analysis revealed that ZEEP (adjusted odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04-0.78) and Society of Thoracic Surgeons(STS) scores (adjusted OR 2.31, 95% CI 1.53-3.49) were significantly associated with a reduced requirement for perioperative transfusions. No significant difference was observed between the two groups in terms of PPCs (p = 0.824). Atelectasis was the most common complication in both groups (ZEEP: 35.7%, PEEP: 40%, P = 0.832).

Conclusions: ZEEP and STS scores were associated with significantly reduced requirement for perioperative transfusion rates during elective OPCAB surgery. However, ZEEP did not significantly affect the incidence of PPCs.

Keywords: Blood transfusion; Coronary artery bypass; Off-pump; Positive end-expiratory pressure; Postoperative complications; Pulmonary atelectasis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Institutional Review Board (Research Ethics Committee of the Graduate School of Medicine, Chiba University) approved the study protocol (#M10313) and waived the requirement for individual informed consent due to the retrospective nature of the study. Instead, an opt-out approach was implemented, with study details and the option to decline participation disclosed on the hospital’s website. This ensured patient autonomy and compliance with ethical guidelines for retrospective studies. The study was conducted in accordance with the Clinical Trials Act of Japan and the Declaration of Helsinki. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient population. ECMO, extracorporeal membrane oxygenation. Patients undergoing coronary artery bypass surgery without cardiopulmonary bypass at a single hospital were excluded from the exclusion criteria. ECMO Conversion was defined as patients who required extracorporeal circulation due to intraoperative hemodynamic instability. Eligible patients for analysis were classified according to the type of end-expiratory positive pressure used
Fig. 2
Fig. 2
Comparison of mean and peak airway pressures between the Zero End-Expiratory Pressure (ZEEP) group and the Positive End-Expiratory Pressure (PEEP) group. ZEEP, Zero End-Expiratory Pressure; PEEP, Positive End-Expiratory Pressure. The graph illustrates the comparison of mean and peak airway pressures between the two groups, with the vertical axis representing the airway pressures. The PEEP group shows significantly higher values in both mean and peak airway pressures compared to the ZEEP group
See this image and copyright information in PMC

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