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Publications

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Ppublish

PubMed: 40323450 DOI: 10.1007/s00134-025-07901-5

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.

Intensive Care Med 51(5):849-860

Authors: Jean-Marc Tadié, Alexandre Ouattara, Bruno Laviolle, Mathieu Lesouhaitier, Maxime Esvan, Chloé Rousseau, Murielle Grégoire, Baptiste Gaudriot, Nicolas Nesseler, François Labaste, Pascale Sanchez, Bertrand Marcheix, Antoine Beurton, Pauline Dureau, Pierre Demondion, Olivier Fouquet, Emmanuel Rineau, Julien Amour, Jean-Philippe Verhoye, Alain Mercat, Nicolas Terzi, Karin Tarte, Adrien Bouglé, Erwan Flecher

Affiliations

  • Department of Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire Rennes, Université de Rennes 1, Rennes, France.
  • SITI Laboratory, UMR U1236, INSERM, University of Rennes, EFS, Rennes University Hospital, Rennes, France.
  • Centre d'investigation Clinique de Rennes (CIC1414), Inserm, Centre Hospitalier Universitaire Rennes, Université de Rennes 1, Rennes, France.
  • Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, Magellan Medico-Surgical Centre, Bordeaux, France.
  • UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, INSERM, Pessac, France.
  • CHU Rennes, Univ Rennes, Inserm, UMR_S 1085 (IRSET), CIC 1414, Rennes, France.
  • Department of Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire Rennes, Université de Rennes 1, Rennes, France.
  • SITI Laboratory, UMR U1236, INSERM, University of Rennes, EFS, Rennes University Hospital, Rennes, France.
  • Centre d'investigation Clinique de Rennes (CIC1414), Inserm, Centre Hospitalier Universitaire Rennes, Université de Rennes 1, Rennes, France.
  • Department of Anesthesia and Critical Care, Pontchaillou, Rennes University Hospital, Rennes, France.
  • Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
  • Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
  • Department of Anesthesiology and Critical Care Medicine, Sorbonne University, Cardiology Institute, GRC 29, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
  • Thoracic and Cardiovascular Surgery Department, Groupe Hospitalier Pitié-Salpétrière, Institute of Cardiology, Sorbonne Université, APHP, Paris, France.
  • Department of Cardiac Surgery, University Hospital of Angers, Angers, France.
  • Department of Anesthesiology and Critical Care, Angers University, Angers, France.
  • Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery Paris Sud (IPRA), Hôpital Privé Jacques Cartier, Ramsay Health Care, Massy, France.
  • Department of Vascular and Cardio-Thoracic Surgery, Rennes University Hospital, Rennes, France.
  • Medical Intensive Care Unit, Vent'Lab, Angers University Hospital, University of Angers, 4 Rue Larrey, Angers, France.

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 cmH 2O 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).

MeSH

Tidal Volume, Incidence, Critical Care, Cardiopulmonary Bypass, Intensive Care Units, Ventilation, Infections