Individualized Flow-controlled versus Pressure-controlled Ventilation in Cardiac Surgery: A Randomized Controlled Trial
Abstract
Background: Patients undergoing on-pump cardiac surgery are at high risk for perioperative lung injury and a hyperinflammatory state associated with postoperative complications. The authors investigated the hypothesis that flow-controlled ventilation (FCV) reduces the inflammatory stimulus compared to conventional pressure-controlled ventilation (PCV) in this patient cohort. FCV has the unique feature of controlling airway flows during inspiration and expiration and the potential to reduce mechanical power of invasive ventilation. Methods: In this single-center randomized controlled trial, 140 adult patients undergoing cardiac surgery with cardiopulmonary bypass were allocated 1:1 to FCV or PCV from August 10, 2020, to November 16, 2022. Participants received perioperatively either individualized FCV with a compliance-guided positive end-expiratory pressure (PEEP) and a compliance-guided driving pressure (ΔP) or PCV with a compliance-guided PEEP and ΔP for tidal volumes of 6 to 8 ml/kg predicted body weight. Postoperative plasmatic interleukin 8 (IL-8) levels 6 h after cardiopulmonary bypass were defined as the primary endpoint. Explorative secondary outcomes included incidences of postoperative pulmonary and extrapulmonary complications and hospital length of stay. Results: Median postoperative IL-8 levels did not differ significantly between FCV and PCV (FCV, 3.08 vs. PCV, 3.60; β, 0.08 pg/ml; 95% CI, −0.17 to 0.33; P = 0.573). ΔP values and tidal volumes were higher in…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 140 participants or records.
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