Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial

Huiqing Ge, Ling Lin, Ying Xu, Peifeng Xu, Kailiang Duan, Qing Pan, Kejing Ying, Huiqing Ge, Ling Lin, Ying Xu, Peifeng Xu, Kailiang Duan, Qing Pan, Kejing Ying

Abstract

Importance: Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients.

Objectives: To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients.

Main outcomes and measures: A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared.

Results: A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min-1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m-2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively).

Conclusions and relevance: Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.

Keywords: airway pressure release ventilation; cardiopulmonary bypass; circulatory function; mechanical ventilation; respiratory function.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Ge, Lin, Xu, Xu, Duan, Pan and Ying.

Figures

FIGURE 1
FIGURE 1
Study Enrollment and study protocol. In total, 138 patients were screened in the present study. Ninety-five patients were enrolled, and ultimately 39 patients were randomized.

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