Comparison of Four Different Recruitment Maneuvers in Patients After Coronary Surgery

Study Overview
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Brief Summary
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The risk of respiratory failure after cardiac surgery is high, and it may result in many complications. The maneuver of alveolar recruitment may improve the oxygen transport in the human organism. The investigators compare three different types of alveolar recruitment in patient after cardiac surgery, to reveal which one is better.

Detailed Description
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The study compares three different approaches to alveolar recruitment maneuvers in the immediate postoperative period after off-pump coronary bypass grafting.

Official Title
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Comparison of Different Types of Postoperative Pulmonary Recruitment and Predicting Its Efficacy Following Off-pump Coronary Artery Bypass Grafting

Conditions
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Hypoxemia, Recruitment

Intervention / Treatment
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* Procedure: Alveolar recruitment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18 and 75 Off-pump coronary artery bypass grafting Possibility to discontinue respiratory support in the first day after intervention Exclusion Criteria: Signs of ARDS COPD in decompensation phase Requirement for inotropic support(epinephrine >0,1 mcg/kg/hr) Bronchiectases Pregnancy Morbid obesity Aortic aneurism AMI in previous month

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Recruitment 40x40<br>The group where recruitment is performed by increase in airway pressure up to 40 cm H2O for 40 seconds | Procedure: Alveolar recruitment<br>* Four approaches: CPAP 40 cm H2O Peak pressure 40 cm H2O PEEP 15 cm H2O for 300 sec no intervention (controls)<br>* Other names: CONTROLS;|
| Active Comparator: Recruitment PEAK40<br>Increase in peak airway pressure up to 40 cm H2O during tidal ventilation | Procedure: Alveolar recruitment<br>* Four approaches: CPAP 40 cm H2O Peak pressure 40 cm H2O PEEP 15 cm H2O for 300 sec no intervention (controls)<br>* Other names: CONTROLS;|
| Active Comparator: Recruitment 15x300<br>Recruitment by increase in airway PEEP up to 15 cm H2O for 300 sec | Procedure: Alveolar recruitment<br>* Four approaches: CPAP 40 cm H2O Peak pressure 40 cm H2O PEEP 15 cm H2O for 300 sec no intervention (controls)<br>* Other names: CONTROLS;|
| Active Comparator: No recruitment<br>No recruitment is performed: standard respiratory support. | Procedure: Alveolar recruitment<br>* Four approaches: CPAP 40 cm H2O Peak pressure 40 cm H2O PEEP 15 cm H2O for 300 sec no intervention (controls)<br>* Other names: CONTROLS;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Respiratory support | The duration of the postoperative respiratory support | 24 hrs | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of postoperative atelectasis | Incidence of atelectases during 24 hrs | 24 hrs | 
| Incidence of reintubation |  | 24 Hrs | 
| Oxygenation | Changes in PaO2/FiO2 ratio | 12 hrs after extubation | 
| Length of ICU and hospital stay | Length of ICU and hospital stay | 28 Days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Recruitment, Coronary artery bypass grafting, Postoperative period