title: Perioperative Ventilatory Management in Cardiac Surgery: A French Nationwide Survey.
abstract: Protective ventilation is associated with a lower incidence of pulmonary complications. However, there are few published data on routine pulmonary management in adult cardiac surgery. The present study's primary objective was to survey pulmonary management in this high-risk population, as practiced by anesthesiologists in France. All 460 registered France-based cardiac anesthesiologists were invited (by e-mail) to participate in an online survey in January-February 2015. The survey's questionnaire was designed to assess current practice in pre-, per-, and postoperative pulmonary management. In all, 198 anesthesiologists (43% of those invited) participated in the survey. Other than during the cardiopulmonary bypass (CPB) per se, 179 anesthesiologists (91% of respondees) [95% confidence interval (CI): 87-95] used a low-tidal-volume approach (6-8 mL/kg), whereas techniques based on positive end-expiratory pressure and recruitment maneuvers vary greatly from 1 anesthesiologist to another. During CPB, 104 (53%) [95% CI: 46-60] anesthesiologists withdrew mechanical ventilation (with disconnection, in some cases) and 97 (49%) [95% CI: 42-56] did not prescribe positive end-expiratory pressure. One hundred sixty-five (83%) [95% CI: 78-88] anesthesiologists stated that a written protocol for peroperative pulmonary management was not available. Twenty (10%) [95% CI: 6-14] and 11 (5%) [95% CI: 2-8] anesthesiologists stated that they did use protocols for ventilator use and recruitment maneuvers, respectively. The preoperative period (pulmonary examinations and prescription of additional assessments) and the postoperative period (extubation, and noninvasive ventilation) periods vary greatly from 1 anesthesiologist to another. The great majority of French cardiac anesthesiologists use a low tidal volume during cardiac surgery (other than during CPB per se). However, pulmonary management procedures varied markedly from 1 anesthesiologist to another. There is a clear need for large clinical studies designed to identify best practice in pulmonary management.
authors.affiliation: From the Anesthesiology and Critical Care Department (M-OF, BC, J-LG, J-LH), University Hospital of Caen; EA 4650 (MOF, JLH), Caen Basse-Normandie University, Esplanade de la Paix, Caen; Anesthesiology and Critical Care Department (P-GG, HD, EL), Amiens University Medical Center, Amiens; and INSERM U 1088 (P-GG, HD, EL), University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens cedex, France.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Fischer
authors.forename: Benoît
authors.initials: B
authors.lastname: Courteille
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gérard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
mesh_terms: D000776:Anesthesiology; D001291:Attitude of Health Personnel; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000379:methods*; D011795:Surveys and Questionnaires; D013990:Tidal Volume / Q000502:physiology