Fiorentino, FrancescaFrancescaFiorentinoJaaly, Emad AlEmad AlJaalyDurham, Andrew LAndrew LDurhamAdcock, Ian MIan MAdcockLockwood, GeoffreyGeoffreyLockwoodRogers, ChrisChrisRogersAscione, RaimondoRaimondoAscioneReeves, Barney CBarney CReevesAngelini, Gianni DGianni DAngelini2019-05-102020-05-022019-06Journal of Cardiac Surgery, 2019, 34 (6), pp.385-3990886-0440http://hdl.handle.net/10044/1/69522OBJECTIVE: 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.© 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.14044cardiopulmonary bypasslow-frequency ventilationlung biopsylung protectionnuclear factor κ-light-chain-enhancer of activated B cellsJournal Articlehttps://www.dx.doi.org/10.1111/jocs.14044PG/13/9/299901540-8191