Low-frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial

Francesca Fiorentino, Emad Al Jaaly, Andrew L Durham, Ian M Adcock, Geoffrey Lockwood, Chris Rogers, Raimondo Ascione, Barney C Reeves, Gianni D Angelini*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

1 Citation (Scopus)
14 Downloads (Pure)

Abstract

Objective: Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti-inflammatory effects of low-frequency ventilation (LFV), as measured by nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) p65 pathway activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left collapsed in patients undergoing coronary artery bypass grafting (CABG). Methods: Two groups parallel randomized controlled trial. The primary outcome was inflammation measured by NF-κB p65 activation in pre- and post-CPB lung biopsies. Secondary outcomes were additional inflammatory markers in both biopsy tissue and blood. Results: Thirty-seven patients were randomly allocated to LFV (18) and to both lungs left collapsed (19). The mean concentration of NF-κB p65 in the biopsies before chest closure (adjusted for pre-CPB concentration) was higher in the LFV group compared to both lungs left collapsed group but this was not significant (0.102, 95% confidence interval, −0.022 to 0.226, P = 0.104). There were no significant differences between groups in the other inflammatory markers measured in tissue and blood. Conclusions: In patients undergoing elective CABG, the use of LFV during CPB when compared to both lungs left collapsed does not seem to reduce inflammation in lung biopsies and blood.

Original languageEnglish
Pages (from-to)385-399
Number of pages15
JournalJournal of Cardiac Surgery
Volume34
Issue number6
Early online date2 May 2019
DOIs
Publication statusPublished - 1 Jun 2019

Structured keywords

  • Centre for Surgical Research
  • BTC (Bristol Trials Centre)

Keywords

  • cardiopulmonary bypass
  • low-frequency ventilation
  • lung biopsy
  • lung protection
  • nuclear factor κ-light-chain-enhancer of activated B cells

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