Expiratory Flow Limitation and Mechanical Ventilation During Cardiopulmonary Bypass in Cardiac Surgery
Mitral Regurgitation, Aortic Regurgitation
About this trial
This is an interventional prevention trial for Mitral Regurgitation focused on measuring Cardiopulmonary bypass, Mechanical ventilation, Expiratory Flow Limitation, Best PEEP
Eligibility Criteria
Inclusion criteria:
- Elective cardiac surgery, with median sternotomy and two-lungs ventilation;
- Patients scheduled for mitral valve regurgitation and/or aortic valve regurgitation surgery, performed with CPB and aortic cross-clamping;
- Adult patients (age 18 or higher);
- Ability to provide informed consent.
- High risk for respiratory dysfunction, defined as 1 of: preoperative hypoxemia (arterial oxygen saturation < 92% in room air or arterial oxygen partial pressure < 60 mmHg at blood gas analysis or a PaO2/FiO2 ratio < 200 at basal blood gas analysis); preoperative obesity (BMI > 30); preoperative ejection fraction < 50%; preoperative NYHA class > II; age > 65 years.
Exclusion criteria:
- Non-elective cardiac surgery;
- Anticipated circulatory arrest, TAVI, Mitraclip;
- Patient's refusal;
- Pregnancy;
- Thoracotomic approach, with one lung ventilation;
- Previous pulmonary resection;
- Patients with acute kidney injury requiring dialysis;
- Patients with chronic kidney insufficiency (stage III or greater);
- Patients already intubated before arrival in operating theatre;
- Pneumonia in the previous 30 days.
Sites / Locations
- Ospedale San Raffaele
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
Placebo Comparator
PEEP and CPAP
ZEEP and CPAP
PEEP and NO VM
ZEEP and NO VM
Patients will be ventilated with positive end-expiratory pressure(PEEP) before and after cardiopulmonary bypass(CPB); during CPB continous positive airway pressure(CPAP) will be adopted.
Patients will be ventilated without PEEP(ZEEP) before and after cardiopulmonary bypass(CPB); during CPB continous positive airway pressure(CPAP) will be adopted.
Patients will be ventilated with positive end-expiratory pressure(PEEP) before and after cardiopulmonary bypass(CPB); during CPB no mechanical ventilation will be adopted(no VM)
Patients will be ventilated without PEEP(ZEEP) before and after cardiopulmonary bypass(CPB); during CPB no mechanical ventilation will be adopted(no VM)