This study evaluates the influence of alveolar recruitment maneuver, protocolized liberation from respiratory support and monitoring of Integrated Pulmonary Index on the duration of the mechanical ventilation and the number of pulmonary complications in the early postoperative period after cardiac surgery.
The outcome of elective off-pump coronary artery bypass grafting (OPCAB) can be significantly compromised due to early postoperative pulmonary complications. The risk of pulmonary complications including acute respiratory distress syndrome (ARDS), atelectases, and early ventilator-associated pneumonia remains inappropriate. Therefore, the maneuvers improving pulmonary aeration and the early restoration of spontaneous breathing activity can be of clinical value. Protocol-driven liberation from mechanical ventilation (CMV) can decrease the duration of CMV as well as the number of pulmonary complications. INTELLiVENT-Assisted spontaneous ventilation (INTELLiVENT-ASV) is a new approach, that may be as effective as conventional protocol-driven liberation from CMV. In parallel, the thorough postoperative monitoring of pulmonary function during both postoperative mechanical ventilation and spontaneous breathing is also of a great value. One of the novel approaches to respiratory monitoring is Integrated Pulmonary Index (IPI). The Integrated Pulmonary Index merges four vital parameters including end-tidal carbon dioxide (EtCO2), respiratory rate, pulse rate, and oxygen saturation (SpO2) measured by capnography and pulse oximetry into a single index value utilizing fuzzy logic model .
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Masking
SINGLE
Enrollment
40
Discontinuation with INTELLiVENT-ASV mode: discontinuation from mechanical ventilation in the early postoperative period will be provided by quick-wean option of INTELLiVENT-ASV mode
Discontinuation with SIMV mode: discontinuation with SIMV mode: discontinuation from mechanical ventilation in the early postoperative period will be provided in SIMV mode using physician driven algorithm
City hospital # 1 / Northern State Medical University,
Arkhangelsk, Russia
Duration of postoperative mechanical ventilation
Participants will be followed for the duration of mechanical ventilation, an expected average of 4 hrs
Time frame: 24 hrs
Reduced incidence of postoperative respiratory complications
* Hypoxemia determined as partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) \< 300 mm Hg. * Atelectases. * Nosocomial (ventilator-associated) pneumonia. * Hypoxemia determined as PaO2/FiO2 \< 300 mm Hg. * Atelectases. * Nosocomial (ventilator-associated) pneumonia. Hypoxemia determined as PaO2/FiO2 \< 300 mm Hg, atelectases, • Nosocomial (ventilator-associated) pneumonia.
Time frame: up to 28 days postoperatively
Duration of intensive care unit stay
Participants will be followed for the duration of the ICU stay, an expected average of 48 hrs
Time frame: 72 hours
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