АNALYSIS OF PULMONARY COMPLICATIONS DEPENDING ON MECHANICAL VENTILATION MODES IN OBESE PATIENTS UNDERGOING CARDIAC SURGERY
DOI:
https://doi.org/10.32782/2411-9164.23.2-9Keywords:
obesity, mechanical ventilation, transpulmonary pressure, cardiac surgery, pulmonary complicationsAbstract
In obese patients, cardiac surgical procedures are associated with a significant risk of respiratory complications such as atelectasis, pneumonia, exacerbation of chronic obstructive pulmonary disease, and respiratory failure. The aim of this study was to compare the incidence of postoperative pulmonary complications depending on the mode of mechanical ventilation in obese patients undergoing cardiac surgery. Materials and Methods. This prospective randomized study included 60 obese patients undergoing coronary artery bypass grafting. In group A (n=30), mechanical ventilation was guided by transpulmonary pressure measurements, whereas in group B (n=30), it was guided by driving pressure. The study assessed gas exchange parameters and the risk of pulmonary complications. Results. At baseline, there were no significant differences between the groups in demographic, anthropometric, or functional characteristics. Similarly, no statistically significant differences were observed in blood gas parameters, surgery duration, cardiopulmonary bypass time, or anesthetic technique. In the postoperative period, patients in the transpulmonary pressure-guided ventilation group had a significantly lower incidence of pulmonary complications (20.0% vs. 63.3%; p=0.0006), a reduced need for non-invasive ventilation (16.7% vs. 40.0%; p=0.045), and a lower incidence of atelectasis (6.67% vs. 26.7%; p=0.038). The length of stay in the intensive care unit was also significantly shorter in group A (p=0.022), while the overall duration of hospitalization did not differ between the groups (p=0.948). Conclusions. The results highlight the importance of individualizing mechanical ventilation settings based on transpulmonary pressure in obese patients undergoing cardiac surgery to prevent respiratory complications and optimize postoperative recovery.
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