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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2019

01-10-2019 | Heart Surgery | Seven-Day Profile Publication

Effect of open-lung vs conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial

Authors: David Lagier, François Fischer, William Fornier, Thi Mum Huynh, Bernard Cholley, Benoit Guinard, Bob Heger, Gabrielle Quintana, Judith Villacorta, Francoise Gaillat, Romain Gomert, Su Degirmenci, Pascal Colson, Marion Lalande, Samir Benkouiten, Tam Hoang Minh, Matteo Pozzi, Frederic Collart, Christian Latremouille, Marcos F. Vidal Melo, Lionel J. Velly, Samir Jaber, Jean-Luc Fellahi, Karine Baumstarck, Catherine Guidon, the PROVECS Study Group

Published in: Intensive Care Medicine | Issue 10/2019

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Abstract

Purpose

To evaluate whether a perioperative open-lung ventilation strategy prevents postoperative pulmonary complications after elective on-pump cardiac surgery.

Methods

In a pragmatic, randomized, multicenter, controlled trial, we assigned patients planned for on-pump cardiac surgery to either a conventional ventilation strategy with no ventilation during cardiopulmonary bypass (CPB) and lower perioperative positive end-expiratory pressure (PEEP) levels (2 cm H2O) or an open-lung ventilation strategy that included maintaining ventilation during CPB along with perioperative recruitment maneuvers and higher PEEP levels (8 cm H2O). All study patients were ventilated with low-tidal volumes before and after CPB (6 to 8 ml/kg of predicted body weight). The primary end point was a composite of pulmonary complications occurring within the first 7 postoperative days.

Results

Among 493 randomized patients, 488 completed the study (mean age, 65.7 years; 360 (73.7%) men; 230 (47.1%) underwent isolated valve surgery). Postoperative pulmonary complications occurred in 133 of 243 patients (54.7%) assigned to open-lung ventilation and in 145 of 245 patients (59.2%) assigned to conventional ventilation (p = 0.32). Open-lung ventilation did not significantly reduce the use of high-flow nasal oxygenotherapy (8.6% vs 9.4%; p = 0.77), non-invasive ventilation (13.2% vs 15.5%; p = 0.46) or new invasive mechanical ventilation (0.8% vs 2.4%, p = 0.28). Mean alive ICU-free days at postoperative day 7 was 4.4 ± 1.3 days in the open-lung group vs 4.3 ± 1.3 days in the conventional group (mean difference, 0.1 ± 0.1 day, p = 0.51). Extra-pulmonary complications and adverse events did not significantly differ between groups.

Conclusions

A perioperative open-lung ventilation including ventilation during CPB does not reduce the incidence of postoperative pulmonary complications as compared with usual care. This finding does not support the use of such a strategy in patients undergoing on-pump cardiac surgery.

Trial registration

Clinicaltrials.gov Identifier: NCT 02866578. https://​clinicaltrials.​gov/​ct2/​show/​NCT02866578
Appendix
Available only for authorised users
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Metadata
Title
Effect of open-lung vs conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial
Authors
David Lagier
François Fischer
William Fornier
Thi Mum Huynh
Bernard Cholley
Benoit Guinard
Bob Heger
Gabrielle Quintana
Judith Villacorta
Francoise Gaillat
Romain Gomert
Su Degirmenci
Pascal Colson
Marion Lalande
Samir Benkouiten
Tam Hoang Minh
Matteo Pozzi
Frederic Collart
Christian Latremouille
Marcos F. Vidal Melo
Lionel J. Velly
Samir Jaber
Jean-Luc Fellahi
Karine Baumstarck
Catherine Guidon
the PROVECS Study Group
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05741-8

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