Mechanical ventilation with low tidal volumes appears to provide benefit in patients having noncardiac surgery; however, whether it is beneficial in patients having cardiac surgery is unclear.
We retrospectively examined patients having elective cardiac surgery requiring cardiopulmonary bypass through a median sternotomy approach who received mechanical ventilation with a single lumen endotracheal tube from January 2010 to mid-August 2016. Time-weighted average tidal volume (milliliter per kilogram predicted body weight [PBW]) during the duration of surgery excluding cardiopulmonary bypass was analyzed. The association between tidal volumes and postoperative oxygenation (measured by arterial partial pressure of oxygen (Pao2)/fraction of inspired oxygen ratio [Pao2/Fio2]), impaired oxygenation (Pao2/Fio2 <300), and clinical outcomes were examined.
Of 9359 cardiac surgical patients, larger tidal volumes were associated with slightly worse postoperative oxygenation. Postoperative Pao2/Fio2 decreased an estimated 1.05% per 1 mL/kg PBW increase in tidal volume (97.5% confidence interval [CI], −1.74 to −0.37; PBon = .0005). An increase in intraoperative tidal volumes was also associated with increased odds of impaired oxygenation (odds ratio [OR; 97.5% CI]: 1.08 [1.02–1.14] per 1 mL/kg PBW increase in tidal volume; PBon = .0029), slightly longer intubation time (5% per 1 mL/kg increase in tidal volume (hazard ratio [98.33% CI], 0.95 [0.93–0.98] per 1 mL/kg PBW; PBon < .0001), and increased mortality (OR [98.33% CI], 1.34 [1.06–1.70] per 1 mL/kg PBW increase in tidal volume; PHolm = .0144). An increase in intraoperative tidal volumes was also associated with acute postoperative respiratory failure (OR [98.33% CI], 1.16 [1.03–1.32] per 1 mL/kg PBW increase in tidal volume; PHolm = .0146), but not other pulmonary complications.
Lower time-weighted average intraoperative tidal volumes were associated with a very modest improvement in postoperative oxygenation in patients having cardiac surgery.
- Question: Is mechanical ventilation with low tidal volumes beneficial for cardiac surgical patients?
- Findings: Smaller intraoperative tidal volumes were associated with slightly improved postoperative oxygenation and a reduction in acute postoperative respiratory failure, but not other pulmonary complications.
- Meaning: Mechanical ventilation with small tidal volumes was associated with a very modest improvement in postoperative oxygenation and minor improvement in clinical pulmonary complications.