EFFECTS OF CONTINUOUS VENTILATION DURING CARDIOPULMONARY BYPASS IN PREVENTING POST-OPERATIVE PULMONARY COMPLICATIONS IN OPEN HEART SURGERY

Abstract

Objective: To compare continuous lung ventilation at low minute volume and non-ventilation during Cardiopulmonary bypass s(CPB) in preventing post-operative pulmonary complications in open heart surgeries.

Study Design: A randomized control trial

Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Disease from December 2015- February 2016

Material and Method: A prospective, randomized study was carried out. The study was approved by the Institutions Ethics and Review Board and written informed consent was obtained from every patient. In total, 100 patients undergoing elective CABG were enrolled in this prospective, randomized clinical trial. On the day of surgery, the patients were selected randomly selected using non probability purposive sampling
method into continuous ventilation [CV] group (n = 54) and open lung [OL] group (n = 46). PaO2 was routinely measured after the induction of anesthesia and endotracheal intubation, before CPB, just after termination of CPB, just before extubation in the ICU and then at regular intervals of 4 hours till discharge to HDU. PaO2/ FiO2 was calculated from the obtained values to compare the both groups. Any PPCs like development of pleural effusion, atelectatic lung on Chest X-Ray, lobar lung collapse or requirement of NIV every 4-6 hourly during the first 48 hours were also noted. CICU LOS was also recorded.

Results: Both the groups had no statistically significant difference. There was no major difference in PaO2/ FiO2 ratios at termination of CPB, extubation, 6 hours after extubation and at 24 hours after extubation. There was statistically significant reduction in incidence of atelectasis (p value = 0.08) and requirement of NIV (0.07) in CV group as compared to OL group. However, the incidence of pleural effusion, pneumonia, and lobar
lung collapse were found to be equivocal.

Conclusion: We conclude that low tidal volume low respiratory rate ventilation during CPB is effective in reducing atelectatic pulmonary complications in open heart surgeries.