The impact of transpulmonary pressure – guided optimization of mechanical ventilation on gas exchange and inflammatory response in obese patients undergoing cardiac surgery
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https://orcid.org/0009-0009-7284-2876
Abstract
The aim – to analyze the impact of optimizing mechanical ventilation (MV) based on transpulmonary pressure measurements on blood gas parameters and activation of the pro-inflammatory response in the lungs during cardiac surgery.
Materials and methods. This prospective randomized study included 60 obese patients undergoing coronary artery bypass grafting. In Group A (n=30), MV optimization was performed based on transpulmonary pressure measurements, while in Group B (n=30), optimization was guided by the driving pressure. We assessed gas exchange parameters, cytokine levels (IL-6 and TNF-α) in bronchoalveolar lavage fluid, and the risk of pulmonary complications using the ARISCAT score.
Results. At baseline, no significant differences were found between the groups in terms of demographic, anthropometric, or functional characteristics. The need for recruitment maneuvers after weaning from cardiopulmonary bypass was significantly lower by 20.0 % in Group A compared to Group B (2 [6.67 %] vs. 8 [26.7 %], χ2=4.32, p=0.038). Postoperatively, IL-6 levels in Group A were significantly lower (72.4±18.1 pg/mL vs. 96.2±20.5 pg/mL, p<0.01), as were TNF-α levels (35.6±9.8 pg/mL vs. 52.3±11.4 pg/mL, p<0.01) compared to Group B. Group A also showed better arterial oxygenation (paO₂: 91.2±7.5 mm Hg vs. 84.6±9.2 mm Hg, p=0.03) than Group B.
Conclusions. The data obtained confirm the benefits of a transpulmonary pressure-oriented ventilation strategy, which may positively influence the postoperative course in obese patients undergoing cardiac surgery.
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References
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