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Research ArticleOriginal Research

Effect of Recruitment Maneuvers and PEEP on Respiratory Failure
After Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial

Priscilla Amaru, Bertrand Delannoy, Thibaut Genty, Olivier Desebbe, Florent Laverdure, Saida Rezaiguia-Delclaux and François Stéphan
Respiratory Care August 2021, 66 (8) 1306-1314; DOI: https://doi.org/10.4187/respcare.08607
Priscilla Amaru
Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
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Bertrand Delannoy
Anesthesiology, Clinique de la Sauvegarde, Lyon, France.
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Thibaut Genty
Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
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Olivier Desebbe
Anesthesiology, Clinique de la Sauvegarde, Lyon, France.
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Florent Laverdure
Anesthesiology, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
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Saida Rezaiguia-Delclaux
Anesthesiology, Clinique de la Sauvegarde, Lyon, France.
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François Stéphan
Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Obesity may increase the risk of respiratory failure after cardiothoracic surgery. A recruitment maneuver followed by PEEP might decrease the risk of respiratory failure in obese subjects. We hypothesized that the routine use after heart surgery of a recruitment maneuver followed by high or low PEEP level would decrease the frequency of respiratory failure in obese subjects.

METHODS: In a pragmatic, randomized controlled trial, we assigned obese subjects (ie, with body mass index [BMI] ≥ 30 kg/m2) in the immediate postoperative period of cardiothoracic surgery to either volume control ventilation with 5 cm H2O of PEEP (control group) or a recruitment maneuver followed by 5 or 10 cm H2O of PEEP in the intervention arms (RM5 and RM10 groups, respectively). The primary outcome was the proportion of subjects with postextubation respiratory failure, defined as the need for re-intubation, bi-level positive airway pressure, or high-flow nasal cannula within the first 48 h.

RESULTS: The study included 192 subjects: 65 in the control group (BMI 33.5 ± 3.2 kg/m2), 66 in the RM5 group (BMI 34.5 ± 3.2 kg/m2, and 61 in RM10 group (BMI 33.8 ± 4.8 kg/m2). Postextubation respiratory failure occurred in 14 subjects in the control group (21.5% [95% CI 13.3–35.3]), 21 subjects in the RM5 group (31.8% [95% CI 21.2–44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4–26.7]) (P = .07). The recruitment maneuver was stopped prematurely due to severe hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P = .28). There were no significant differences between the 3 groups for the frequencies of atelectasis, pneumonia, and death in the ICU.

CONCLUSIONS: The routine use after heart surgery of a recruitment maneuver followed by 5 or 10 cm H2O of PEEP did not decrease the frequency of respiratory failure in obese subjects. A recruitment maneuver followed by 5 cm H2O of PEEP is inappropriate.

  • obesity
  • cardiac surgery
  • recruitment maneuver
  • positive end-expiratory pressure
  • respiratory failure
  • randomized controlled trial

Footnotes

  • Correspondence: François Stéphan MD, Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France. E-mail: f.stephan{at}ghpsj.fr
  • Dr Stéphan has disclosed a relationship with Fisher & Paykel Healthcare. The other authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (8)
Respiratory Care
Vol. 66, Issue 8
1 Aug 2021
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Effect of Recruitment Maneuvers and PEEP on Respiratory Failure
After Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial
Priscilla Amaru, Bertrand Delannoy, Thibaut Genty, Olivier Desebbe, Florent Laverdure, Saida Rezaiguia-Delclaux, François Stéphan
Respiratory Care Aug 2021, 66 (8) 1306-1314; DOI: 10.4187/respcare.08607

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Effect of Recruitment Maneuvers and PEEP on Respiratory Failure
After Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial
Priscilla Amaru, Bertrand Delannoy, Thibaut Genty, Olivier Desebbe, Florent Laverdure, Saida Rezaiguia-Delclaux, François Stéphan
Respiratory Care Aug 2021, 66 (8) 1306-1314; DOI: 10.4187/respcare.08607
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Keywords

  • obesity
  • cardiac surgery
  • recruitment maneuver
  • positive end-expiratory pressure
  • respiratory failure
  • randomized controlled trial

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