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Effect of protective ventilation throughout the intubation period on perioperative oxygenation in patients undergoing MIDCABG: a randomised controlled trial.

Min Qian·Zhukai Cong·Ning Yang·Binlong Li·Wenxuan Liu·Changyi Wu·Mao Xu
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Abstract

INTRODUCTION: Minimally invasive direct coronary artery bypass grafting (MIDCABG) requires prolonged one-lung ventilation (OLV), increasing postoperative pulmonary complications (PPCs) risk. We investigated whether protective lung ventilation (PLV) throughout intubation benefits MIDCABG patients. METHODS: In this single-center randomized study, MIDCABG patients received PLV (low tidal volume of 6-8&#x2009;mL&#xb7;kg-1, PEEP of 6&#x2009;cm H2O, alveolar recruitment maneuvers) or conventional mechanical ventilation (CMV, tidal volume of 8-10&#x2009;mL&#xb7;kg-1, without PEEP or maneuvers) from tracheal intubation to extubation. The primary outcome was perioperative oxygenation, assessed by the PaO2/FiO2 ratio. RESULTS: Sixty patients (n = 30 per group) were enrolled. Compared with CMV, PLV improved PaO2/FiO2 ratios (mean difference at OLV60: 34.56&#x2009;mmHg; 95% CI: 11.78-57.33; p&#x2009;<&#x2009;0.01), shortened median durations of postoperative mechanical ventilation (median difference: -4.5&#x2009;h, 95% CI: -8.5 to -0.5; p&#x2009;=&#x2009;0.013) and hospital stay (median difference: -3.0&#x2009;days, 95% CI: -5.0 to -1.0; p&#x2009;=&#x2009;0.019). PLV also reduced driving pressure, airway pressure and intrapulmonary shunt during OLV (all p&#x2009;<&#x2009;0.05). Desaturation occurred in 23.3% of CMV patients and 13.3% of PLV patients (p&#x2009;=&#x2009;0.506). Hemodynamic parameters were generally comparable between groups, except for lower MPAP and PVRI in the PLV group during OLV and after ICU admission (p&#x2009;<&#x2009;0.05). The incidence of PPCs did not differ between groups. CONCLUSIONS: In patients undergoing MIDCABG, PLV applied throughout intubation improved perioperative oxygenation and shortened the duration of postoperative mechanical ventilation and hospital stay, but did not reduce PPCs. CLINICAL TRIAL REGISTRATION: ChiCTR1900022005.

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HumansFemaleMaleMiddle AgedAgedPostoperative ComplicationsCoronary Artery BypassOne-Lung VentilationIntubation, IntratrachealLength of StayOxygenRespiration, ArtificialPerioperative PeriodTidal VolumePerioperative CareProtective lung ventilationlung mechanicsminimally invasive direct coronary artery bypass graftingperioperative oxygenationpostoperative pulmonary complicationsJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov't

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Min Qian, Zhukai Cong, Ning Yang, Binlong Li, Wenxuan Liu, Changyi Wu, Mao Xu. 2026-08-26. Effect of protective ventilation throughout the intubation period on perioperative oxygenation in patients undergoing MIDCABG: a randomised controlled trial.. https://doi.org/10.1080/07853890.2026.2720367

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Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't resourceAged subjectCoronary Artery Bypass subjectFemale subjectHumans subjectIntubation, Intratracheal subjectJournal Article subjectLength of Stay subjectMale subjectMiddle Aged subjectOne-Lung Ventilation subjectOxygen subjectPerioperative Care subjectPerioperative Period subjectRandomized controlled trials studylung mechanics subject

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