Impact of Lung Recruitment Maneuvers on Driving Pressure in Cardiac Surgery

Study Overview
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Brief Summary
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In anesthesia the incidence of postoperative pulmonary complications is frequent, especially in cardiac surgery where the incidence can reach 10%. Respiratory morbidity in cardiac surgery is favored by multiple factors and is higher compared to anesthesia in general surgery. The prevention of these complications is a major challenge in the management of patients. Influence of driving pressure level on respiratory morbidity was first demonstrated in management of acute respiratory distress syndrome (ARDS) in resuscitation. More recently, this notion has been introduced in anesthesia, with a correlation between increase driving pressure level and increase of post-operative respiratory complications. A method should reduce these levels of driving pressure: performing lung recruitment maneuvers. This technique has been successfully tested in abdominal surgery in particular in a study published by Futier et al.. They systematized and standardized lung recruitment maneuvers and showed a decrease of postoperative pulmonary complications in abdominal surgery. Thus, the realization of lung recruitment maneuvers, already used at the discretion of the practitioner, is now recommended by several teams of experts. The investigators propose in this before-after trial to evaluate variation in driving pressure due to systematic use of lung recruitment maneuvers, observed in patients operated in elective or urgent surgery. The secondary objective is to evaluate their impact on postoperative pulmonary complications.

Detailed Description
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This is a retrospective, before / after, monocentric trial.

Official Title
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Impact of Lung Recruitment Maneuvers on Driving Pressure in Cardiac Surgery (IMPREMO): Before - After Trial

Conditions
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Respiration, Artificial, Lung Diseases, Atelectasis, Cardiac Surgical Procedures, Anesthesia, General

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients receiving elective or urgent cardiac surgery with cardiopulmonary bypass Exclusion Criteria: Emergency or salvage surgery Patient under guardianship Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Before group<br>The before group is the control group. We collect retrospective data in consecutive patients operated before the implementation of lung recruitment maneuvers protocol | |
| After group<br>We collect data in consecutive patients operated after the implementation of lung recruitment maneuvers protocol. This lung recruitment maneuvers will be realised along the surgery, (After tracheal intubation, per-CPB, post-CPB). Each recruitment maneuver consisted of applying a continuous positive airway pressure of 30 cm of water for 30 seconds | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Driving pressure variation due to lung recruitment maneuvers | cmH2O | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of postoperative pulmonary complications | percentage | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Driving pressure, Postoperative pulmonary complications