Coronary Artery Bypass Graft Surgery (CABG), Postoperative Pulmonary Complications, Prolonged Mechanical Ventilation
Conditions
Keywords
intraoperative ventilation, lung-protective ventilation
Brief summary
This prospective observational study evaluates the association between intraoperative mechanical power (MP) - a composite measure of the total energy delivered to the lungs during mechanical ventilation - and postoperative pulmonary complications (PPCs) and prolonged mechanical ventilation in adult patients undergoing elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Intraoperative ventilatory parameters including tidal volume, respiratory rate, airway pressures, and PEEP will be recorded and used to calculate MP and driving pressure (DP). No additional interventions will be applied beyond standard clinical care.
Detailed description
This single-center prospective observational study enrolls adult patients undergoing elective first-time isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Mechanical power (MP) will be calculated as: MP = 0.098 × RR × VT × \[PIP - 0.5 × (Pplat - PEEP)\], normalized to predicted body weight (norMP = MP/PBW). Male PBW (kg) = 50 + 0.91 × \[height (cm) - 152.4\]; female PBW (kg) = 45.5 + 0.91 × \[height (cm) - 152.4\]. Driving pressure (DP) = Pplat - PEEP. Ventilatory parameters (VT, RR, peak pressure, plateau pressure, PEEP, FiO2, EtCO2) and arterial blood gases (PaO2/FiO2, PaCO2, lactate) will be recorded at four standardized time points: T1 (post-intubation), T2 (post- sternotomy), T3 (pre-bypass), and T4 (post-bypass). No additional interventions beyond standard clinical care will be applied. Postoperative outcomes including atelectasis, pneumonia, pleural effusion, prolonged oxygen requirement, need for non-invasive ventilation, re-intubation, duration of mechanical ventilation, and ICU length of stay will be assessed within the first 48 hours. Sample size: 110 patients (α=0.05, power=80%, expected PPC incidence 35% vs 65% in low vs high MP groups, 20% dropout allowance). Statistical analysis will include Mann-Whitney U or t-test, chi-square or Fisher exact test, and logistic regression. Significance: p\<0.05 (two-tailed).
Interventions
Intraoperative ventilatory parameters (tidal volume, respiratory rate, plateau pressure, PEEP) are routinely recorded during CABG surgery. Mechanical power and driving pressure are calculated from these parameters. No additional intervention is applied beyond standard clinical care.
Sponsors
Fusun Gozen
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Scheduled for elective, first-time isolated CABG surgery * Use of cardiopulmonary bypass (CPB) * Intraoperative mechanical ventilation applied under general anesthesia with recordable ventilator data * Provision of written informed consent
Exclusion criteria
* Emergency cardiac surgery * Off-pump CABG (without CPB) * Preoperative requirement for invasive mechanical ventilation * Advanced chronic lung disease * Incomplete or unreliable intraoperative ventilatory data * Intraoperative use of advanced non-standard support (ECMO)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pulmonary Complication | Within the first 48 hours postoperatively | Occurrence of at least one of the following within the first 48 hours postoperatively: atelectasis, pleural effusion, pneumonia, prolonged oxygen requirement, need for non-invasive ventilation (NIV), or re-intubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prolonged Mechanical Ventilation | Up to 7 days postoperatively | Duration of mechanical ventilation greater than 24 hours |
Countries
Turkey (Türkiye)
Contacts
CONTACTFüsun Gözen, MD (Anesthesiology)
Outcome results
None listed