Objective: After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation. Design: A prospective, single-center, randomized, controlled clinical study. Setting: Cardiothoracic operating room and intensive care unit of a university hospital. Patients: Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass. Interventions: Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until PaO2/FIO2 was >375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group. Measurements and Main Results: FRC was measured preoperatively and 1, 3, and 5 days after extubation. Peripheral hemoglobin saturation (SpO2) was measured daily till the third day after extubation while the patient was breathing room air. Hypoxemia was defined by an SpO2 value ≤90%. Averaged over the 5 post-operative days, FRC was significantly higher in the early open lung group and tended to be higher in the late open lung group, in comparison with the CV group (mean ± SEM: CV, 1.8 ± 0.1; late open lung, 1.9 ± 0.1; and early open lung, 2.2 ± 0.1I). In the CV group, 37% of the patients were hypoxic on the third day after extubation, compared with none of the patients in both OLC groups. Conclusions: After cardiac surgery, earlier application of OLC resulted in a significantly higher FRC and fewer episodes of hypoxemia than with CV after extubation. Copyright

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doi.org/10.1097/01.CCM.0000181674.71237.3B, hdl.handle.net/1765/72960
Critical Care Medicine
Pediatric Psychiatry

dos Reis Miranda, D., Gommers, D., Struijs, A., Koetsier, J., van Thiel, R., Schepp, R., … Bogers, A. (2005). Open lung ventilation improves functional residual capacity after extubation in cardiac surgery. Critical Care Medicine, 33(10), 2253–2258. doi:10.1097/01.CCM.0000181674.71237.3B