International Journal of Cardiovascular Sciences. 15/May/2025;38:e20250048.
Mechanical Ventilation: Friend or Foe in Cardiac Surgery?
This Editorial is referred by the Research article "Mechanical Ventilation Time and Mortality After Coronary Artery Bypass Grafting: A Cohort Study".
In this number of the journal, the study “Mechanical ventilation time and mortality after coronary artery bypass grafting: A cohort study” evaluated retrospectively 110 patients of a single center, who had no previous lung or kidney disease, submitted to elective open bypass surgery between January 2018 and February 2020. Their aim was to evaluate the impact of mechanical ventilation (MV) on mortality using multivariate analysis of MV time, age, sex and cardiopulmonary bypass (CPB) time. The patients were divided into two groups: patients who needed more than eight hours on MV and those who needed less than eight hours on MV. There was no difference in weaning protocol or in demographic data except for CPB bypass time: 90 ± 12 minutes in the first group (less than eight hours on MV) and 112 ± 16 minutes in the second group (more than eight hours on MV) (p = 0.03). In the univariate analysis, MV time was associated with mortality (HR 0.7 (0.3-0.9), p = 0.01). The authors concluded that MV time longer than eight hours was a predictor of mortality after cardiac surgery.
I wish things could be simple in intensive care, however it is not. Let’s have a deeper approach and make a fair judgement if MV is the real foe. Let’s begin from the beginning: MV is a key part of advanced life support that may directly interfere with patient’s prognosis, for good and for bad. This is not only because of the duration of MV, but also why and how it is used. First, we must evaluate patient’s characteristics: gender, age, body mass index, frailty, EuroSCORE, transfusion, immunosuppression, previous lung disease (which was excluded in the present study), extravascular lung water (to determine lung edema) and both local (bronchoalveolar lavage) and systemic mediators of inflammatory response. Genetics also play an important role and it is worthwhile to mention that CPB, MV (alveolar pressure and/or mechanical distension), transfusion, sepsis, shock and trauma may increase the risk for lung injury.
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