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

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Title: Low-frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial
Authors: Fiorentino, F
Jaaly, EA
Durham, AL
Adcock, IM
Lockwood, G
Rogers, C
Ascione, R
Reeves, BC
Angelini, GD
Item Type: Journal Article
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.
Issue Date: Jun-2019
Date of Acceptance: 4-Mar-2019
URI: http://hdl.handle.net/10044/1/69522
DOI: 10.1111/jocs.14044
ISSN: 0886-0440
Publisher: Wiley
Start Page: 385
End Page: 399
Journal / Book Title: Journal of Cardiac Surgery
Volume: 34
Issue: 6
Copyright Statement: © 2019 Wiley Periodicals, Inc. This is the accepted version of the following article Fiorentino, F, Al Jaaly, E, Durham, AL, et al. Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial. J Card Surg. 2019; 34: 385‐ 399, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/jocs.14044
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: PG/13/9/29990
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Surgery
Cardiovascular System & Cardiology
cardiopulmonary bypass
low-frequency ventilation
lung biopsy
lung protection
nuclear factor kappa-light-chain-enhancer of activated B cells
RESPIRATORY-DISTRESS-SYNDROME
INFLAMMATORY RESPONSE
GENERAL-ANESTHESIA
CARDIAC-SURGERY
OBESE-PATIENTS
ATELECTASIS
INJURY
PREVENTION
MEDIATORS
PRESSURE
cardiopulmonary bypass
low-frequency ventilation
lung biopsy
lung protection
nuclear factor κ-light-chain-enhancer of activated B cells
Aged
Biomarkers
Cardiopulmonary Bypass
Coronary Artery Bypass
Female
Humans
Inflammation
Intraoperative Complications
Lung
Male
Middle Aged
Pulmonary Atelectasis
Respiration, Artificial
Transcription Factor RelA
Lung
Humans
Inflammation
Intraoperative Complications
Respiration, Artificial
Coronary Artery Bypass
Cardiopulmonary Bypass
Aged
Middle Aged
Female
Male
Transcription Factor RelA
Pulmonary Atelectasis
Biomarkers
cardiopulmonary bypass
low-frequency ventilation
lung biopsy
lung protection
nuclear factor κ-light-chain-enhancer of activated B cells
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: United States
Online Publication Date: 2019-05-02
Appears in Collections:Department of Surgery and Cancer