Effect of protective ventilation throughout the intubation period on perioperative oxygenation in patients undergoing MIDCABG: a randomised controlled trial.

TL;DR

Protective lung ventilation (PLV) throughout intubation in MIDCABG patients improved perioperative oxygenation (PaO2/FiO2 ratio) and reduced postoperative mechanical ventilation duration and hospital stay compared to conventional ventilation, though PPC incidence was comparable.

Key findings

• PLV (6-8 mL·kg⁻¹ tidal volume, 6 cm H₂O PEEP, recruitment maneuvers) improved PaO2/FiO2 ratio by mean 34.56 mmHg vs conventional ventilation (p<0.01)
• Postoperative mechanical ventilation time reduced by median 4.5 hours and hospital stay by median 3 days with PLV (p=0.013 and p=0.019 respectively)
• PLV reduced driving pressure, airway pressure, and intrapulmonary shunt during one-lung ventilation, with lower mean pulmonary artery pressure and pulmonary vascular resistance index
• Postoperative pulmonary complications incidence did not differ between groups; desaturation trend favored PLV but was not statistically significant (13.3% vs 23.3%, p=0.506)

Why this matters at the bedside

Relevant to perioperative management of MIDCABG patients; PLV strategies may improve oxygenation and reduce ventilation/ICU burden without increasing adverse effects, though does not prevent PPC development.