title: Protection strategies during cardiopulmonary bypass: ventilation, anesthetics and oxygen.
abstract: OBJECTIVE
  To provide an update of research findings regarding the protection strategies utilized for patients undergoing cardiopulmonary bypass (CPB), including perioperative ventilatory strategies, different anesthetic regimens, and inspiratory oxygen fraction. The article will review and comment on some of the most important findings in this field to provide a global view of strategies that may improve patient outcomes by reducing inflammation.
  
  
  RESULTS
  Postoperative complications are directly related to ischemia and inflammation. The application of lung-protective ventilation with lower tidal volumes and higher positive end-expiratory pressure reduces inflammation, thereby reducing postoperative pulmonary complications. Although inhalation anesthesia has clear cardioprotective effects compared with intravenous anesthesia, several factors can interfere to reduce cardioprotection. Hyperoxia up to 0.8 FiO(2) may confer benefits without increasing oxidative stress or postoperative pulmonary complications. During the early postoperative period, inhalation anesthesia prior to extubation and the application of preventive noninvasive ventilation may reduce cardiac and pulmonary complications, improving patients' outcomes.
  
  
  CONCLUSIONS
  Lung-protective mechanical ventilation, inhalation anesthesia, and high FiO(2) have the potential to reduce postoperative complications in patients undergoing CPB; however, larger, well powered, randomized control trials are still needed.
authors.affiliation: Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrando
authors.forename: Marina
authors.initials: M
authors.lastname: Soro
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Belda
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*
chemical_list: D000777:Anesthetics