ObjectiveTo investigate the current status of routine practice and perspective of anesthesiologists regarding ventilation strategies during cardiac surgery, and to analyze whether there is a gap between the clinical application and theoretical understanding of lung-protective ventilation (LPV) strategies. MethodsWe conducted a multi-institutional cross-sectional survey of anesthesiologists working at high-volume (>1000 cardiac procedures each year) Chinese hospitals. The electronic questionnaire was designed and distributed from September 2021 to February 2022. ResultsA total of 323 replies were collected and 297 (92.0%) replies were valid. Among the respondents, 84.8% (252/297) performed the combination of low tidal volume (VT), positive end-expiratory pressure (PEEP) and alveolar recruitment maneuver (ARM) during non-CPB period. The vast majority of respondents (90.6%, 269/297) ventilated patients with the VT of 6-8 mL/kg. 92.3% (274/297) of respondents applied PEEP, among those 57.9% (172/297) set a PEEP level <5 cm H2O. Most of the respondents (67.3%, 200/297) performed intraoperative ARM, and manual ARM was used by 86.2% (256/297) of anesthesiologists. During CPB, 89.9% (267/297) of respondents withdrew mechanical ventilation, and 29.6% (88/297) performed ARM. ConclusionThis national survey in China showed that the majority of anesthesiologists adopted LPV strategy with the combination of low VT, PEEP and ARM during cardiac surgery. Except VT, the intraoperative ventilator settings varied widely from one anesthesiologist to another. Meanwhile, there is a gap between the clinical practice and theoretical understanding of LPV.
Perioperative mechanical ventilation plays a role in lung injury and postoperative pulmonary complications, yet a consensus in the literature concerning the key clinical question of how to best provide lung protection during mechanical ventilation in surgical patients is lacking. It is necessary to develop an expert consensus on perioperative mechanical ventilation suitable for Chinese anesthesiologists to better guide clinical practice. The experts from the Anesthesia Committee of Chengdu Medical Association and the Chongqing Medical Association Anesthesiology Branch were organized by West China Hospital of Sichuan University to propose the question regarding the perioperative mechanical ventilation, and the current literature was then reviewed, and expert opinions were solicited to provide evidence-based guidance. Subsequently, the expert panel reached a consensus and formulated 28 recommendations with evidence of moderate to high quality using the modified Delphi method.