title: Perioperative ventilatory strategies in cardiac surgery.
abstract: Recent data promote the utilization of prophylactic protective ventilation even in patients without acute respiratory distress syndrome (ARDS), and especially after cardiac surgery. The implementation of specific perioperative ventilatory strategies in patients undergoing cardiac surgery can improve both respiratory and extra-pulmonary outcomes. Protective ventilation is not limited to tidal volume reduction. The major components of ventilatory management include assist-controlled mechanical ventilation with low tidal volumes (6-8 mL kg(-1) of predicted body weight) associated with higher positive end-expiratory pressure (PEEP), limitation of fraction of inspired oxygen (FiO2), ventilation maintenance during cardiopulmonary bypass, and finally recruitment maneuvers. In order for such strategies to be fully effective, they should be integrated into a multimodal approach beginning from the induction and continuing over the postoperative period.
authors.affiliation: Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada. Electronic address: francois.lellouche@criucpq.ulaval.ca.
authors.forename: François
authors.initials: F
authors.lastname: Lellouche
authors.affiliation: Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada; CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Univ. Bordeaux, Adaptation Cardiovasculaire à l'ischémie, U1034 et INSERM, Adaptation Cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France. Electronic address: mathieu.delorme@chu-bordeaux.fr.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Delorme
authors.affiliation: Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada. Electronic address: jbuss@criucpq.ulaval.ca.
authors.forename: Jean
authors.initials: J
authors.lastname: Bussières
authors.affiliation: CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Univ. Bordeaux, Adaptation Cardiovasculaire à l'ischémie, U1034 et INSERM, Adaptation Cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France. Electronic address: alexandre.ouattara@chu-bordeaux.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D010100:Oxygen / Q000378:metabolism; D019990:Perioperative Care / Q000379:methods*; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000517:prevention & control; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000150:complications; D013990:Tidal Volume
chemical_list: D010100:Oxygen
keywords: PEEP; cardiac surgery; cardiopulmonary bypass; mechanical ventilation; oxygen; recruitment; tidal volume