AUTHOR=Ge Huiqing , Lin Ling , Xu Ying , Xu Peifeng , Duan Kailiang , Pan Qing , Ying Kejing 

TITLE=Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial

JOURNAL=Frontiers in Physiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.684927

DOI=10.3389/fphys.2021.684927

ISSN=1664-042X

ABSTRACT=<sec><title>Importance</title><p>Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients.</p></sec><sec><title>Objectives</title><p>To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients.</p></sec><sec><title>Main Outcomes and Measures</title><p>A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared.</p></sec><sec><title>Results</title><p>A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min<sup>–1</sup>⋅m<sup>2</sup>; <italic>p</italic> &lt; 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m<sup>–2</sup>; <italic>p</italic> &lt; 0.05) were also observed in the APRV group after 4 h as well as within the first day (<italic>p</italic> &lt; 0.05). Compared to the PCV group, the PaO2/FiO<sub>2</sub> was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, <italic>p</italic> &lt; 0.05) and within the first three days (<italic>p</italic> &lt; 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (<italic>p</italic> &lt; 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (<italic>p</italic> = 0.248 and 0.424, respectively).</p></sec><sec><title>Conclusions and Relevance</title><p>Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.</p></sec>