title: Pulmonary Perfusion and Ventilation during Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes after Cardiac Surgery.
abstract: OBJECTIVE
  Clinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass (CBP) are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Major academic tertiary referral medical center.
  
  
  METHODS
  Two hundred seventy-four consecutive patients who underwent open heart surgery with CBP 2009-2013.
  
  
  METHODS
  The outcomes of 86 patients who received pulmonary perfusion and ventilation during CBP were retrospectively compared to the control group of 188 patients.
  
  
  RESULTS
  Respiratory complications rates were similar in both groups (33.7 vs. 33.5%), as were the rates of postoperative pneumonia (4.7 vs. 4.3%), pleural effusions (13.9 vs. 12.2%), and re-intubations (9.3 vs. 9.1%). Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3 vs. 8.5%) and atrial fibrillation (33.7 vs. 28.2%) were equivalent in both groups. Incidence of sepsis (8.1 vs. 5.3%), postoperative stroke (2.3 vs. 2.1%), acute kidney injury (2.3 vs. 3.7%), and renal failure (5.8 vs. 3.7%) was likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8 vs. 5.3%,p= 0.031) and the need for mediastinal re-exploration (17.4 vs. 9.6%,p= 0.0633) were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. Intensive care unit (ICU) and hospital stays, and the ICU readmission rates (7.0 vs. 8.0%) were similar in both groups.
  
  
  CONCLUSIONS
  Simultaneous pulmonary perfusion and ventilation during CBP were not associated with improved clinical outcomes.
authors.affiliation: Anesthesiology, University of Miami Miller School of Medicine , Miami, FL , USA.
authors.forename: Yiliam F
authors.initials: YF
authors.lastname: Rodriguez-Blanco
authors.affiliation: Private Practice, Anesthesiology , Miami, FL , USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Gologorsky
authors.affiliation: Cardiovascular Surgery, University of Miami Miller School of Medicine , Miami, FL , USA.
authors.forename: Tomas Antonio
authors.initials: TA
authors.lastname: Salerno
authors.affiliation: Division of Biostatistics, Department of Public Health Sciences, University of Miami , Miami, FL , USA.
authors.forename: Kaming
authors.initials: K
authors.lastname: Lo
authors.affiliation: Anesthesiology, Allegheny General Hospital , Pittsburgh, PA , USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Gologorsky
keywords: cardiac surgery outcome; cardiopulmonary bypass; postoperative complications; pulmonary perfusion; pulmonary ventilation