Single-step vs Stepwise Lung Recruitment Maneuvers After Cardiopulmonary Bypass

Summary

This prospective randomized controlled trial aims to compare the hemodynamic and pulmonary effects of single-step and stepwise lung recruitment maneuvers in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. After separation from cardiopulmonary bypass, patients will be randomized to receive either a single-step sustained inflation recruitment maneuver or a stepwise incremental recruitment maneuver, both combined with 8 cmH₂O positive end-expiratory pressure. The primary outcome is the change in cardiac index before and after the recruitment maneuver. Secondary outcomes include lung ultrasound atelectasis score, and hemodynamic parameters.

Eligibility

Inclusion Criteria:

* Age 18-80 years
* ASA (American Society of Anesthesiologists) II-IV
* Patients undergoing elective cardiac surgery (coronary artery bypass grafting, mitral valve replacement, aortic valve replacement)

Exclusion Criteria:

* Emergency surgery
* Presence of perioperative arrhythmia
* \<35% left ventricular ejection fraction
* \>50 mmHg systolic pulmonary artery pressure
* Known chronic obstructive pulmonary disease or interstitial lung disease
* Pneumothorax
* Mean arterial pressure \<60 mmHg during recruitment maneuver
* New York Heart Association (NYHA) class III-IV heart failure
* Advanced cardiomyopathy or severe mitral regurgitation
* Cross-clamp time longer than 2 hours
* Requirement for high-dose inotropic or vasopressor support
* Patients who cannot be extubated after postoperative 24 hours

Conditions2

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