Trial reportPaediatric anaesthesia2026
Effects of Intraoperative Ventilation Strategies on Ventilation Inhomogeneity and Inflammatory Response in Pediatric Cardiac Surgery-A Randomized Pilot Study.
Trial report in Paediatric anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundRespiratory arrest during cardiopulmonary bypass (CPB) in pediatric cardiac surgery risks lung dysfunction including derecruitment, atelectasis, and inflammation. Continuous positive airway pressure (CPAP) and lung-protective ventilation (LPV) during aortic cross-clamping show inconsistent results in mitigating these risks.
aimsTo investigate whether LPV during aortic cross-clamping under CPB affects postoperative respiratory mechanics and ventilation inhomogeneity compared to apnea or CPAP.
methodsThis prospective, randomized pilot study compared three ventilation strategies during aortic cross-clamping under CPB: apnea, CPAP (5 mbar), and LPV. LPV was standardized using pressure-controlled ventilation at a positive end-expiratory pressure of 5 mbar, individualized driving pressure (20% of the pre-cross clamp inspiratory pressure), and age-adjusted respiratory rate. Recruitment maneuvers were applied at the end of CPB. Respiratory mechanics were assessed. Ventilation distribution was measured preoperatively and postoperatively under spontaneous breathing and mechanical ventilation using Electrical Impedance Tomography. Blood was analyzed pre- and postoperatively for pulmonary and systemic inflammatory markers. Feasibility of LPV was assessed. Statistical analysis used linear mixed-effects models.
resultsDriving pressure increased (11.8 (2.6) to 12.9 (2.6) mbar) and dynamic compliance decreased (9.9 (7.3) to 8.5 (7.4) Pa L
conclusionIn this pilot study, ventilation strategies did not differ in their effect on ventilation distribution, respiratory mechanics, or inflammatory markers when recruitment maneuvers were uniformly applied after CPB. LPV was feasible.
trial registrationGerman Clinical Trials Register: DRKS00030219; https://drks.de/search/de/trial/DRKS00030219.
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