Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial
Objective Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti‐inflammatory effects of low‐frequency ventilation (LFV), as measured by nuclear factor κ‐light‐chai...
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| Veröffentlicht in: | Journal of cardiac surgery 2019-06, Vol.34 (6), p.385-399 |
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| creator | Fiorentino, Francesca Jaaly, Emad Al Durham, Andrew L. Adcock, Ian M. Lockwood, Geoffrey Rogers, Chris Ascione, Raimondo Reeves, Barney C. Angelini, Gianni D. |
| description | Objective
Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti‐inflammatory effects of low‐frequency ventilation (LFV), as measured by nuclear factor κ‐light‐chain‐enhancer of activated B cells (NF‐κB) p65 pathway activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left collapsed in patients undergoing coronary artery bypass grafting (CABG).
Methods
Two groups parallel randomized controlled trial. The primary outcome was inflammation measured by NF‐κB p65 activation in pre‐ and post‐CPB lung biopsies. Secondary outcomes were additional inflammatory markers in both biopsy tissue and blood.
Results
Thirty‐seven patients were randomly allocated to LFV (18) and to both lungs left collapsed (19). The mean concentration of NF‐κB p65 in the biopsies before chest closure (adjusted for pre‐CPB concentration) was higher in the LFV group compared to both lungs left collapsed group but this was not significant (0.102, 95% confidence interval, −0.022 to 0.226, P = 0.104). There were no significant differences between groups in the other inflammatory markers measured in tissue and blood.
Conclusions
In patients undergoing elective CABG, the use of LFV during CPB when compared to both lungs left collapsed does not seem to reduce inflammation in lung biopsies and blood. |
| doi_str_mv | 10.1111/jocs.14044 |
| format | Article |
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Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti‐inflammatory effects of low‐frequency ventilation (LFV), as measured by nuclear factor κ‐light‐chain‐enhancer of activated B cells (NF‐κB) p65 pathway activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left collapsed in patients undergoing coronary artery bypass grafting (CABG).
Methods
Two groups parallel randomized controlled trial. The primary outcome was inflammation measured by NF‐κB p65 activation in pre‐ and post‐CPB lung biopsies. Secondary outcomes were additional inflammatory markers in both biopsy tissue and blood.
Results
Thirty‐seven patients were randomly allocated to LFV (18) and to both lungs left collapsed (19). The mean concentration of NF‐κB p65 in the biopsies before chest closure (adjusted for pre‐CPB concentration) was higher in the LFV group compared to both lungs left collapsed group but this was not significant (0.102, 95% confidence interval, −0.022 to 0.226, P = 0.104). There were no significant differences between groups in the other inflammatory markers measured in tissue and blood.
Conclusions
In patients undergoing elective CABG, the use of LFV during CPB when compared to both lungs left collapsed does not seem to reduce inflammation in lung biopsies and blood.</description><identifier>ISSN: 0886-0440</identifier><identifier>EISSN: 1540-8191</identifier><identifier>DOI: 10.1111/jocs.14044</identifier><identifier>PMID: 31045289</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Biomarkers - metabolism ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Female ; Humans ; Inflammation - diagnosis ; Intraoperative Complications - diagnosis ; Intraoperative Complications - pathology ; Intraoperative Complications - prevention & control ; low‐frequency ventilation ; Lung - metabolism ; Lung - pathology ; lung biopsy ; lung protection ; Male ; Middle Aged ; nuclear factor κ‐light‐chain‐enhancer of activated B cells ; Pulmonary Atelectasis - diagnosis ; Pulmonary Atelectasis - pathology ; Pulmonary Atelectasis - prevention & control ; Respiration, Artificial - methods ; Transcription Factor RelA - metabolism</subject><ispartof>Journal of cardiac surgery, 2019-06, Vol.34 (6), p.385-399</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3654-c3c14b5214639895354f95c586888dd3fb964c5de413961144cbe9aa951710c93</citedby><cites>FETCH-LOGICAL-c3654-c3c14b5214639895354f95c586888dd3fb964c5de413961144cbe9aa951710c93</cites><orcidid>0000-0002-1753-3730</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjocs.14044$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjocs.14044$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31045289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fiorentino, Francesca</creatorcontrib><creatorcontrib>Jaaly, Emad Al</creatorcontrib><creatorcontrib>Durham, Andrew L.</creatorcontrib><creatorcontrib>Adcock, Ian M.</creatorcontrib><creatorcontrib>Lockwood, Geoffrey</creatorcontrib><creatorcontrib>Rogers, Chris</creatorcontrib><creatorcontrib>Ascione, Raimondo</creatorcontrib><creatorcontrib>Reeves, Barney C.</creatorcontrib><creatorcontrib>Angelini, Gianni D.</creatorcontrib><title>Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial</title><title>Journal of cardiac surgery</title><addtitle>J Card Surg</addtitle><description>Objective
Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti‐inflammatory effects of low‐frequency ventilation (LFV), as measured by nuclear factor κ‐light‐chain‐enhancer of activated B cells (NF‐κB) p65 pathway activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left collapsed in patients undergoing coronary artery bypass grafting (CABG).
Methods
Two groups parallel randomized controlled trial. The primary outcome was inflammation measured by NF‐κB p65 activation in pre‐ and post‐CPB lung biopsies. Secondary outcomes were additional inflammatory markers in both biopsy tissue and blood.
Results
Thirty‐seven patients were randomly allocated to LFV (18) and to both lungs left collapsed (19). The mean concentration of NF‐κB p65 in the biopsies before chest closure (adjusted for pre‐CPB concentration) was higher in the LFV group compared to both lungs left collapsed group but this was not significant (0.102, 95% confidence interval, −0.022 to 0.226, P = 0.104). There were no significant differences between groups in the other inflammatory markers measured in tissue and blood.
Conclusions
In patients undergoing elective CABG, the use of LFV during CPB when compared to both lungs left collapsed does not seem to reduce inflammation in lung biopsies and blood.</description><subject>Aged</subject><subject>Biomarkers - metabolism</subject><subject>Cardiopulmonary Bypass</subject><subject>Coronary Artery Bypass</subject><subject>Female</subject><subject>Humans</subject><subject>Inflammation - diagnosis</subject><subject>Intraoperative Complications - diagnosis</subject><subject>Intraoperative Complications - pathology</subject><subject>Intraoperative Complications - prevention & control</subject><subject>low‐frequency ventilation</subject><subject>Lung - metabolism</subject><subject>Lung - pathology</subject><subject>lung biopsy</subject><subject>lung protection</subject><subject>Male</subject><subject>Middle Aged</subject><subject>nuclear factor κ‐light‐chain‐enhancer of activated B cells</subject><subject>Pulmonary Atelectasis - diagnosis</subject><subject>Pulmonary Atelectasis - pathology</subject><subject>Pulmonary Atelectasis - prevention & control</subject><subject>Respiration, Artificial - methods</subject><subject>Transcription Factor RelA - metabolism</subject><issn>0886-0440</issn><issn>1540-8191</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1OAyEURonR2Frd-ACGpTFp5c7ACO5M42-adKGuJwzDGBpmqDBjM658BJ_RJ5Ha6lIWQC6HL_cehI6BTCCu84VTYQKUULqDhsAoGXMQsIuGhPNsHMtkgA5CWBCSJDQl-2iQAqEs4WKI7Mytvj4-K69fO92oHr_ppjVWtsY1uOy8aV6wkr40btnZ2jXS97jolzIEXDmPbRffl961Wq1_XOIr7GVTutq86xIr17TeWRuvrTfSHqK9Stqgj7bnCD3fXD9N78az-e399Go2VmnGaNwV0IIlQLNUcMFSRivBFOMZ57ws06oQGVWs1BRSkQFQqgotpBQMLoAokY7Q6SY3dhbHCm1em6C0tbLRrgt5koCIMiDJInq2QZV3IXhd5Utv6jhlDiRf283XdvMfuxE-2eZ2Ra3LP_RXZwRgA6yM1f0_UfnDfPq4Cf0Gi96HHw</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Fiorentino, Francesca</creator><creator>Jaaly, Emad Al</creator><creator>Durham, Andrew L.</creator><creator>Adcock, Ian M.</creator><creator>Lockwood, Geoffrey</creator><creator>Rogers, Chris</creator><creator>Ascione, Raimondo</creator><creator>Reeves, Barney C.</creator><creator>Angelini, Gianni D.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1753-3730</orcidid></search><sort><creationdate>201906</creationdate><title>Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial</title><author>Fiorentino, Francesca ; Jaaly, Emad Al ; Durham, Andrew L. ; Adcock, Ian M. ; Lockwood, Geoffrey ; Rogers, Chris ; Ascione, Raimondo ; Reeves, Barney C. ; Angelini, Gianni D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3654-c3c14b5214639895354f95c586888dd3fb964c5de413961144cbe9aa951710c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Biomarkers - metabolism</topic><topic>Cardiopulmonary Bypass</topic><topic>Coronary Artery Bypass</topic><topic>Female</topic><topic>Humans</topic><topic>Inflammation - diagnosis</topic><topic>Intraoperative Complications - diagnosis</topic><topic>Intraoperative Complications - pathology</topic><topic>Intraoperative Complications - prevention & control</topic><topic>low‐frequency ventilation</topic><topic>Lung - metabolism</topic><topic>Lung - pathology</topic><topic>lung biopsy</topic><topic>lung protection</topic><topic>Male</topic><topic>Middle Aged</topic><topic>nuclear factor κ‐light‐chain‐enhancer of activated B cells</topic><topic>Pulmonary Atelectasis - diagnosis</topic><topic>Pulmonary Atelectasis - pathology</topic><topic>Pulmonary Atelectasis - prevention & control</topic><topic>Respiration, Artificial - methods</topic><topic>Transcription Factor RelA - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fiorentino, Francesca</creatorcontrib><creatorcontrib>Jaaly, Emad Al</creatorcontrib><creatorcontrib>Durham, Andrew L.</creatorcontrib><creatorcontrib>Adcock, Ian M.</creatorcontrib><creatorcontrib>Lockwood, Geoffrey</creatorcontrib><creatorcontrib>Rogers, Chris</creatorcontrib><creatorcontrib>Ascione, Raimondo</creatorcontrib><creatorcontrib>Reeves, Barney C.</creatorcontrib><creatorcontrib>Angelini, Gianni D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fiorentino, Francesca</au><au>Jaaly, Emad Al</au><au>Durham, Andrew L.</au><au>Adcock, Ian M.</au><au>Lockwood, Geoffrey</au><au>Rogers, Chris</au><au>Ascione, Raimondo</au><au>Reeves, Barney C.</au><au>Angelini, Gianni D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial</atitle><jtitle>Journal of cardiac surgery</jtitle><addtitle>J Card Surg</addtitle><date>2019-06</date><risdate>2019</risdate><volume>34</volume><issue>6</issue><spage>385</spage><epage>399</epage><pages>385-399</pages><issn>0886-0440</issn><eissn>1540-8191</eissn><abstract>Objective
Pulmonary dysfunction is a common complication in patients undergoing heart surgery. Current clinical practice does not include any specific strategy for lung protection. To compare the anti‐inflammatory effects of low‐frequency ventilation (LFV), as measured by nuclear factor κ‐light‐chain‐enhancer of activated B cells (NF‐κB) p65 pathway activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left collapsed in patients undergoing coronary artery bypass grafting (CABG).
Methods
Two groups parallel randomized controlled trial. The primary outcome was inflammation measured by NF‐κB p65 activation in pre‐ and post‐CPB lung biopsies. Secondary outcomes were additional inflammatory markers in both biopsy tissue and blood.
Results
Thirty‐seven patients were randomly allocated to LFV (18) and to both lungs left collapsed (19). The mean concentration of NF‐κB p65 in the biopsies before chest closure (adjusted for pre‐CPB concentration) was higher in the LFV group compared to both lungs left collapsed group but this was not significant (0.102, 95% confidence interval, −0.022 to 0.226, P = 0.104). There were no significant differences between groups in the other inflammatory markers measured in tissue and blood.
Conclusions
In patients undergoing elective CABG, the use of LFV during CPB when compared to both lungs left collapsed does not seem to reduce inflammation in lung biopsies and blood.</abstract><cop>United States</cop><pmid>31045289</pmid><doi>10.1111/jocs.14044</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0002-1753-3730</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biomarkers - metabolism Cardiopulmonary Bypass Coronary Artery Bypass Female Humans Inflammation - diagnosis Intraoperative Complications - diagnosis Intraoperative Complications - pathology Intraoperative Complications - prevention & control low‐frequency ventilation Lung - metabolism Lung - pathology lung biopsy lung protection Male Middle Aged nuclear factor κ‐light‐chain‐enhancer of activated B cells Pulmonary Atelectasis - diagnosis Pulmonary Atelectasis - pathology Pulmonary Atelectasis - prevention & control Respiration, Artificial - methods Transcription Factor RelA - metabolism |
| title | Low‐frequency ventilation during cardiopulmonary bypass for lung protection: A randomized controlled trial |
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