Use of Airway Pressure Release Ventilation in Morbidly Obese Patients Undergoing Open Heart Surgery
Pulmonary Atelectasis, Morbid Obesity, Pulmonary Complication
About this trial
This is an interventional prevention trial for Pulmonary Atelectasis focused on measuring APRV, Morbid Obesity, Cardiac surgery, Pulmonary Complications
Eligibility Criteria
Inclusion Criteria: Age ≥18 y. Scheduled for open heart Surgery with cardiopulmonary bypass (CPB) pump. Class III Obesity (Morbid obesity): BMI ≥ 40.0 kg/m². Exclusion Criteria: Patients with obstructive lung disease (asthma or chronic obstructive pulmonary disease). Pneumothorax or Surgical emphysema. Mechanical ventilation prior to the operation. Patient Refusal.
Sites / Locations
- Cardiothoracic Academy, Ain Shams University HospitalsRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
APRV group
Standard group
Group A: APRV group (30 Patients) Post operatively, Patients will be ventilated with APRV mode using GE Carescape R860 ventilator Initial Settings15 P high at the P plateau (or desired P mean + 3cm H2O). keep P high below 30-35 cm H2O T high at 4-6 seconds P low at 0 T low at 0.5 to 0.8 seconds. ATC (automatic tube compensation) on. FIO2: 40% Ventilator settings will be adjusted to keep Pco2 between 35-45 mmhg, PO2 > 60 mmhg on FIO2 < 50 % Once Patients are fully conscious and after complete recovery of reflexes with no postoperative bleeding nor hemodynamic instability, weaning of APRV will start as following, P-High will be lowered 2 or 3 cm of H2O pressure at a time, and T Low will be lengthened in 0.5-2.0 s increments, depending on patient tolerance. When the P-high reaches 10 cmH2O and the Thigh reaches 12-15 seconds, change the mode to pressure support (PS) mode PS of 7-8 cmH20 above PEEP of cmh2o then extubation.
Group B: Standard (control) group (30 Patients) Post-operatively, Patients will be ventilated with conventional Synchronized Intermittent Mandatory Ventilation (SIMV) volume control mode using GE Carescape R860 ventilator Initial Settings: 16 Tidal Volume 6-8 ml/kg predicted body weight Respiratory rate (RR) 14 /min Positive end expiratory pressure (PEEP)= 5 cmH2o Pressure Support (PS) = 10 cmH2o Inspiratory time 1.4 Sec FIO2: 40% Ventilator settings will be adjusted to keep Pco2 between 35-45 mmhg, PO2 > 60 mmhg on FIO2 < 50 %