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Randomized Controlled Trial
. 2025 May;51(5):849-860.
doi: 10.1007/s00134-025-07901-5. Epub 2025 May 5.

Maintaining ventilation with very low tidal volume and positive-end expiratory pressure versus no ventilation during cardiopulmonary bypass for cardiac surgery in adults: a randomized clinical trial

Jean-Marc Tadié  1   2   3 , Alexandre Ouattara  4   5 , Bruno Laviolle  6 , Mathieu Lesouhaitier  7   8   9 , Maxime Esvan  9 , Chloé Rousseau  9 , Murielle Grégoire  8 , Baptiste Gaudriot  10 , Nicolas Nesseler  10 , François Labaste  11 , Pascale Sanchez  11 , Bertrand Marcheix  12 , Antoine Beurton  4   5 , Pauline Dureau  13 , Pierre Demondion  14 , Olivier Fouquet  15 , Emmanuel Rineau  16 , Julien Amour  17 , Jean-Philippe Verhoye  18 , Alain Mercat  19 , Nicolas Terzi  7   9 , Karin Tarte  8 , Adrien Bouglé  13 , Erwan Flecher  18 ; VECAR Trial Group and REVA
Affiliations
Randomized Controlled Trial

Maintaining ventilation with very low tidal volume and positive-end expiratory pressure versus no ventilation during cardiopulmonary bypass for cardiac surgery in adults: a randomized clinical trial

Jean-Marc Tadié et al. Intensive Care Med. 2025 May.

Abstract

Purpose: Cardiopulmonary bypass (CPB) during cardiac surgery mechanically circulates and oxygenates the blood, bypassing the heart and lungs. Despite limited evidence, maintaining mechanical ventilation (MV) during CPB is recommended, as ventilator strategies during surgery may reduce the occurrence of postoperative infections. We aimed to determine whether maintaining MV for cardiac surgery would decrease postoperative infections compared with stopping MV during CPB.

Methods: We conducted a multicenter, single-blind, randomized trial among adult patients undergoing scheduled cardiac surgery with CPB in six hospitals in France. During CPB, the tracheal tube was disconnected from the ventilator in the control group (MV- group). In the MV + group, ventilation was maintained during CPB with very low tidal volume ventilation, using a tidal volume of 2.5 mL/kg of predicted body weight, with 5-7 cmH2O positive end expiratory pressure. The primary outcome was the occurrence of all types of postoperative infections within the first 28 days after surgery. There were six secondary evaluation criteria including the number of days of exposure to antibiotics.

Results: A total of 1362 patients were enrolled in the study. Postoperative infection occurred in 74 out of 680 patients (10.9%) in the MV- group, compared to 68 out of 682 patients (10.0%) in the MV + group (relative risk, 0.92; 95% confidence interval [CI] 0.67-1.25; p = 0.58). Antibiotic use was higher in the MV + group than in the MV- group (incidence risk ratio, 1.08; 95% CI 1.02-1.15; p = 0.02). There were no significant differences between the groups for all other secondary outcomes or for the incidence of adverse events.

Conclusions: Maintaining very low tidal volume ventilation with positive end-expiratory pressure during CPB did not reduce postoperative infections at 28 days compared to when mechanical ventilation was stopped during CPB. An unexpectedly higher use of antibiotics was observed when ventilation was maintained.

Trial registration: ClinicalTrials.gov (NCT03372174).

Keywords: Cardiac surgery; Cardiopulmonary bypass; Mechanical ventilation; Postoperative infection.

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Conflict of interest statement

Declarations. Conflicts of interest: We declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort flow diagram. ITT denotes intention-to-treat. CPB denotes cardiopulmonary bypass
Fig. 2
Fig. 2
Kaplan–Meier survival estimates of death from any cause. Data analysis was conducted on the intention-to-treat population. Postoperative mortality rates on day 28 did not differ significantly between the MV + and MV- groups. HR indicates hazard ratio
Fig. 3
Fig. 3
Immunological blood biomarkers in the VECAR Trial. Lymphocytes count, expression of human leukocyte antigen–DR antigen (HLA–DR) on peripheral monocytes, plasmatic levels of Interleukin-10, Interleukin-6, and myeloid-derived suppressor cells (granulocytic myeloid-derived suppressor cells (G-MDSC) and monocytic–myeloid-derived suppressor cells (M-MDSC)) at day 0 (before CPB initiation), day 1 and day 7
See this image and copyright information in PMC

References

    1. Greco G, Shi W, Michler RE, Meltzer DO, Ailawadi G, Hohmann SF, Thourani VH, Argenziano M, Alexander JH, Sankovic K et al (2015) Costs associated with health care-associated infections in cardiac surgery. J Am Coll Cardiol 65(1):15–23 - PMC - PubMed
    1. Aneman A, Brechot N, Brodie D, Colreavy F, Fraser J, Gomersall C, McCanny P, Moller-Sorensen PH, Takala J, Valchanov K et al (2018) Advances in critical care management of patients undergoing cardiac surgery. Intensive Care Med 44(6):799–810 - PubMed
    1. Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD, Perrault LP, Smith PK, Kron IL, Michler RE et al (2014) Management practices and major infections after cardiac surgery. J Am Coll Cardiol 64(4):372–381 - PMC - PubMed
    1. Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 296(20):2460–2466 - PubMed
    1. Sbrana S, Bevilacqua S, Buffa M, Spiller D, Parri MS, Gianetti J, De Filippis R, Clerico A (2005) Post-reperfusion changes of monocyte function in coronary blood after extracorporeal circulation. Cytometry B Clin Cytom 65(1):14–21 - PubMed

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