Flow-controlled versus pressure-controlled ventilation in cardiac surgery with cardiopulmonary bypass – A single-center, prospective, randomized, controlled trial

Spraider, P; Abram, J; Martini, J; Putzer, G; Glodny, B; Hell, T; Barnes, T; Enk, D

doi:10.1016/j.jclinane.2023.111279

Cardiothoracic & vascular anesthesia

Flow-controlled versus pressure-controlled ventilation in cardiac surgery with cardiopulmonary bypass – A single-center, prospective, randomized, controlled trial

J Clin AnesthPublished 3 Oct 2023Randomised controlled trial

Primary result · PaO2/FiO2ResultMedian difference 46 mmHg 95% CI 3–90

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Authors' conclusion

In patients undergoing on-pump, cardiac surgery individualized FCV significantly improved oxygenation and lung tissue aeration compared to PCV.

Study context

Population: Patients scheduled for elective, open, on-pump cardiac surgery, university hospital, Austria50 in primary analysis
Participants: 56 patients

Comparison: Individualized flow-controlled ventilation (FCV) vs pressure-controlled ventilation (PCV) for the duration of cardiac surgery
FCVn = 24
PCVn = 26reference
Primary endpoint: Oxygenation (PaO2/FiO2)
Follow-up: 15 min after intraoperative chest closure

Methodological detailsprospective, non-blinded, single-centre, Enrolment April 2020 to April 2021

Prospective
Non-blinded
Single-centre
Enrolment April 2020 to April 2021

Primary result

PaO2/FiO2 · 15 min after chest closure

Median difference

46 mmHg

95% CI 3–90

P = 0.038

By group

FCV

356

PCV

309

FCV vs PCV

median difference 46 mmHg (95% CI 3–90); P = 0.038

As reported in the abstract

Secondary outcomes

Outcome	FCV	PCV	← Lower with FCV ←→ Higher with FCV →	MD (l/min) (95% CI)	P value
Minute volume required to obtain normocapnia	4.0	6.1	−3−2−101	−2.0 (−2.5 to −1.5)	P < 0.001
			−3−2−101Difference, l/min (linear scale)

Outcome	FCV	PCV	← Lower with FCV ←→ Higher with FCV →	MD (J/min) (95% CI)	P value
Mechanical power	5.1	9.8	−10−505	−5.1 (−6.2 to −4.0)	P < 0.001
			−10−505Difference, J/min (linear scale)

Outcome	FCV	PCV	← Lower with FCV ←→ Higher with FCV →	MD (%) (95% CI)	P value
Non-aerated lung tissue (postoperative CT)	5	7	−6−4−202	−3 (−4 to −1)	P < 0.001
			−6−4−202Difference, % (linear scale)

Original publication

Flow-controlled versus pressure-controlled ventilation in cardiac surgery with cardiopulmonary bypass – A single-center, prospective, randomized, controlled trial. J Clin Anesth. Published 3 October 2023. doi:10.1016/j.jclinane.2023.111279

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