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Thursday, April 14, 2011
Ahead of print: appropriate ventilation during cardiac surgery
Posted by J. Lance Lichtor, M.D.
J. Lance Lichtor, M.D.
Articles are published 1-3 months in advance of when they will appear in print.  For some of these articles the discussion shouldn't wait until the article is in print.  Each week, we present the abstract of one of these articles.  We hope you enjoy this feature.  These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.

Sundar S, Novack V, Jervis K, Patrick Bender S, Lerner A, Panzica P, Mahmood F, Malhotra A, Talmor D: Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients. Anesthesiology 2011

Brief Summary: Low tidal volume ventilation is recommended for patients with acute respiratory distress syndrome. The authors found that though low tidal volume ventilation when used for patients undergoing elective cardiac surgery did not shorten time to extubation, those patients were more likely to be extubated and breathing without assistance 6-8 h after surgery. Those patients were also less likely to need postoperative reintubation. More study is needed.

Abstract

Background: Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation.

Methods: A single-center randomized controlled trial was undertaken in 149 patients undergoing elective cardiac surgery. Ventilation with 6 versus 10 ml/kg tidal volume was compared. Ventilator settings were applied immediately after anesthesia induction and continued throughout surgery and the subsequent intensive care unit stay. The primary endpoint of the study was time to extubation. Secondary endpoints included the proportion of patients extubated at 6 h and indices of lung mechanics and gas exchange as well as patient clinical outcomes.

Results: Median ventilation time was not significantly different in the low tidal volume group; a median (interquartile range) of 450 (264 –1,044) min was achieved compared with 643 (417–1,032) min in the control group (P0.10). However, a higher proportion of patients in the low tidal volume group was free of any ventilation at 6 h: 37.3% compared with 20.3% in the control group (P 0.02). In addition, fewer patients in the low tidal volume group required reintubation (1.3 vs. 9.5%; P 0.03).

Conclusions: Although reduction of tidal volume in mechanically ventilated patients undergoing elective cardiac surgery did not significantly shorten time to extubation, several improvements were observed in secondary outcomes. When these data are combined with a lack of observed complications, a strategy of reduced tidal volume could still be beneficial in this patient population.

Disclaimer: Articles appearing in this Published Ahead-of-Print section have been peer-reviewed and accepted for publication in this journal and posted online before print publication. Articles appearing here may contain statements, opinions, and information that have errors in facts, figures, or interpretation. Accordingly, Lippincott Williams & Wilkins, the editors and authors and their respective employees are not responsible or liable for the use of any such inaccurate or misleading data, opinion or information contained in the articles in this section.

Your comments are welcome.
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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