Efficacy of Continuous Positive Airway Pressure (CPAP) 5 cmH2O during Cardiopulmonary Bypass (CPB) on Partial Pressure of Oxygen in Elderly Patients Undergoing Cardiac Surgery

Pamila Saengsup; Wittawat Pibul; Wiput Kojarunchitt; Thongnet Nuengchaiyot

Authors

Pamila Saengsup Rajavithi Hospital
Wittawat Pibul Rajavithi Hospital
Wiput Kojarunchitt Rajavithi Hospital
Thongnet Nuengchaiyot Rajavithi Hospital

Keywords:

CPAP, Cardiopulmonary bypass, Cardiac surgery, Elderly

Abstract

Background: The number of elderly patients undergoing open-heart surgery is rising due to increase in life expectancy. Despite advances in surgical techniques and perioperative care, postoperative pulmonary complications (PPCs) remain common, often indicated by reduced arterial oxygen levels influencing ventilator weaning. Oxygenation decline may result from pulmonary collapse during Cardiopulmonary Bypass (CPB), ischemia-reperfusion injury, inflammation, and impaired alveolar-capillary function. Objective: To evaluate the effect of Continuous positive airway pressure (CPAP) at 5 cmH₂O during CPB on arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients. Method: This single-center randomized controlled study included 110 elderly patients undergoing open-heart surgery with CPB. Patients were assigned to one of two intraoperative ventilation strategies: 1) no mechanical ventilation and no oxygen supplied during CPB (control group) or 2) CPAP at 5 cmH₂O during CPB (CPAP group). Arterial blood gas samples were collected at multiple consecutive stages throughout the surgery. Postoperative outcomes included mechanical ventilation duration, intensive care unit (ICU) stay, and PPCs incidence. Results: The CPAP group showed significantly higher PaO₂/FiO₂ ratios and PaO₂ at 5 minutes post-CPB (403.53±104.43 mmHg and 403.5±104.42 mmHg in control group vs. 445.20±85.31 mmHg and 445.19±85.30 mmHg in CPAP group, p = .024) and after sternal closure (361.90±139.48 mmHg and 353.33±149.30 mmHg in control group vs. 417.42±117.90 mmHg and 413.07±125.87 mmHg in CPAP group, p = .026 and p = .025 respectively), but not after ICU admission. No differences were found in PPCs incidence (42% control versus 31% CPAP), ICU stay (p = .78) and extubating time (p = .26). Conclusions: Appling CPAP 5 cmH₂O during CPB was associated with better oxygenation in early stage and did not reduce the incidence of PPCs in elderly patients undergoing cardiac surgery.

References

Seese L, Sultan I, Gleason TG, Navid F, Wang Y, Thoma F, et al. The impact of major postoperative complications on long-term survival after cardiac surgery. Ann Thorac Surg 2020;110(1):128-35.

Curiel-Balsera E, Mora-Ordoñez JM, Castillo-Lorente E, Benitez-Parejo J, Herruzo-Avilés A, Ravina-Sanz JJ, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care 2013;28(4): 397-404.

Ball L, Costantino F, Pelosi P. Postoperative complications of patients undergoing cardiac surgery. Curr Opin Crit Care 2016;22(4):386-92.

Apostolakis E, Filos KS, Koletsis E, Dougenis D. Lung dysfunction following cardiopulmonary bypass. J Card Surg 2010;25(1):47-55.

Chi D, Chen C, Shi Y, Wang W, Ma Y, Zhou R, et al. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017;96(12):e6454.

Schreiber JU, Lancé MD, de Korte M, Artmann T, Aleksic I, Kranke P. The effect of different lung-protective strategies in patients during cardiopulmonary bypass: a meta-analysis and semiquantitative review of randomized trials. J Cardiothorac Vasc Anesth 2012;26(3):448-54.

Berry CB, Butler PJ, Myles PS. Lung management during cardiopulmonary bypass: is continuous positive airways pressure beneficial? Br J Anaesth 1993;71(6):864-8.

Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg 2008;247(4):617-26.

Elhaddad AM, Youssef MF, Ebad AA, Abdelsalam MS, Kamel MM. Effect of ventilation strategy during cardiopulmonary bypass on arterial oxygenation and postoperative pulmonary complications after pediatric cardiac surgery: a randomized controlled study. J Cardiothorac Vasc Anesth 2022;36(12):4357-63.

Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung 2020;198(6):889-96.

Liu J, Li X, Xie W, Wang Y, Xu Z, Bai YX, et al. Risk factors and short-term outcomes of postoperative pulmonary complications in elderly patients after cardiopulmonary bypass. Clin Interv Aging 2024; 19:31-9.

Griffith KA, Sherrill DL, Siegel EM, Manolio TA, Bonekat HW, Enright PL. Predictors of loss of lung function in the elderly: the cardiovascular health study. Am J Respir Crit Care Med 2001;163(1):61-8.

Noguchi S, Saito J, Hashiba E, Kushikata T, Hirota K. Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery. JA Clin Rep 2016;2(1):39.

Yang HH, Chang JC, Jhan JY, Cheng YT, Huang YT, Chang BS, et al. Prognostic value of peak lactate during cardiopulmonary bypass in adult cardiac surgeries: A retrospective cohort study. Tzu Chi Med J 2020;32(4):386-91.

Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J 1999;13(1):197-205.

Suraseranivong R. Physiologic changes in the elderly. GMSMJ 2022;2(2):129-40.

Skloot GS. The effects of aging on lung structure and function. Clin Geriatr Med 2017;33(4):447-57.

Magnusson L, Zemgulis V, Wicky S, Tydén H, Hedenstierna G. Effect of CPAP during cardiopulmonary bypass on postoperative lung function. An experimental study. Acta Anaesthesiol Scand 1998;42(10):1133-8.

Alavi M, Pakrooh B, Mirmesdagh Y, Bakhshandeh H, Babaee T, Hosseini S, et al. The effects of positive airway pressure ventilation during cardiopulmonary bypass on pulmonary function following open heart surgery. Res Cardiovasc Med 2013;2(2):79-84.

Gado AA, Hefnawy SM, Abdelrahim AM, Alberry MA WAA, Madkour MAEF. A randomized controlled comparison of three modes of ventilation during cardiopulmonary bypass on oxygenation in pediatric patients with pulmonary hypertension undergoing congenital heart surgeries. Egyptian Journal of Anaesthesia 2022;38(1):193-200