APRV Versus SIMV in Class III Obesity After Cardiopulmonary Bypass: A Randomized Trial of Postoperative Pulmonary Outcomes | ||
| Egyptian Journal of Anaesthesia | ||
| Volume 41, Issue 1, 2025, Pages 1-9 PDF (639.84 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/egja.2025.401415.1147 | ||
| Authors | ||
| Mohamed Alaaeldin Alhadidy; Mohamed Moien Ellewa; Ahmed Monier Eldemerdash; Sarah Hamdy Elghareeb* | ||
| Department of Anesthesiology, ICU and Pain Management, Ain Shams University, Cairo, Egypt. | ||
| Abstract | ||
| Background and Aims: Patients with class III obesity (BMI ≥ 40 kg/m²) undergoing cardiac surgery with cardiopulmonary bypass (CPB) face high rates of postoperative pulmonary complications. We evaluated whether an Airway Pressure Release Ventilation (APRV)–based open-lung strategy improves outcomes versus conventional Synchronized Intermittent Mandatory Ventilation (SIMV). Patients and Methods: In this single-center, prospective randomized controlled trial, 60 adults with class III obesity scheduled for elective cardiac surgery with CPB were randomized postoperatively to APRV (n = 30) or SIMV (n = 30) in the cardiac surgical ICU. Primary endpoints were oxygenation (PaO₂/FiO₂) and static lung compliance; secondary outcomes included duration of mechanical ventilation, ICU length of stay, and need for post-extubation noninvasive ventilation (NIV). Results: The APRV group showed higher PaO₂/FiO₂ ratios at all time points, with a 48-hour mean difference of 47.1 mmHg (95% CI, 30.2–64.0), and greater static compliance (+14.5 mL/cmH₂O at 6 hours). APRV reduced mechanical ventilation duration (7.4 ± 1.2 vs. 9.3 ± 4.4 hours) and ICU stay (2.2 ± 0.4 vs. 3.1 ± 1.1 days). No APRV patients required post-extubation NIV versus 23.3% in SIMV (NNT = 5). Pneumonia incidence was similar between groups. Conclusions: In class III obese cardiac surgery patients, APRV enhances oxygenation and lung mechanics, accelerates extubation, and reduces ICU resource utilization compared to SIMV. These results support integrating APRV into enhanced recovery protocols; further multicenter trials are warranted. IRB approval: Ain Shams University Protocol Record (FMASU R243 /2022) ClinicalTrials.gov: NCT05670483 (https://clinicaltrials.gov/study/NCT05674253) | ||
| Keywords | ||
| Airway Pressure Release Ventilation (APRV); Cardiopulmonary bypass; Class III obesity; Intensive care unit; Mechanical ventilation; Postoperative pulmonary complications | ||
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