Efficacy of CPAP 5 cmH2O during cardiopulmonary bypass on partial pressure of oxygen in elderly patients undergoing cardiac surgery
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The number of elderly patients undergoing open-heart surgery is rising due to increase in life expectancy. Despite advances in surgical techniques and perioperative care, postoperative pulmonary complications (PPCs) remain common, often indicated by reduced arterial oxygen levels influencing ventilator weaning. Oxygenation decline may result from pulmonary collapse during Cardiopulmonary Bypass (CPB), ischemia-reperfusion injury, inflammation, and impaired alveolar-capillary function. Continuous Positive Airway Pressure (CPAP) 5 cm during CPB on arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients. This single-center randomized controlled study included 110 elderly patients undergoing open-heart surgery with CPB. Patients were assigned to one of two intraoperative ventilation strategies: (1) no mechanical ventilation and no oxygen supplied during CPB (control group) or (2) CPAP at 5 cm
during CPB (CPAP group). Arterial blood gas samples were collected at multiple consecutive stages throughout the surgery. Postoperative outcomes included mechanical ventilation duration, intensive care unit (ICU) stay, and PPCs incidence.
The CPAP group showed significantly higher Pa/Fi
ratios and PaO2 at 5 minutes post-CPB (403.53±104.43 mmHg and 403.5±104.42 mmHg in control group vs. 445.20±85.31 mmHg and 445.19±85.30 mmHg in CPAP group, p = .024) and after sternal closure (361.90±139.48 mmHg and 353.33±149.30 mmHg in control group vs. 417.42±117.90 mmHg and 413.07±125.87 mmHg in CPAP group, P=0.026 and P=0.025 respectively), but not after ICU admission. No differences were found in PPCs incidence (42% control versus 31% CPAP), ICU stay (p = .78) and extubating time (p = .26).
Appling CPAP 5 cm during CPB was associated with better oxygenation in early stage and did not reduce the incidence of PPCs in elderly patients undergoing cardiac surgery
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