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Echeverria-Villalobos et al. Vessel Plus 2019;3:33 Vessel Plus
DOI: 10.20517/2574-1209.2019.12

Review Open Access

Mechanical ventilation and cardiopulmonary
bypass: a narrative review of the mechanistic lung
protective measures

Marco Echeverria-Villalobos, Dolly M. Munlemvo, Juan Fiorda-Diaz, Michael K. Essandoh

Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.

Correspondence to: Prof. Juan Fiorda-Diaz, Department of Anesthesiology, The Ohio State University Wexner Medical Center,
Columbus, OH 43210, USA. E-mail: Juan.Fiorda@osumc.edu

How to cite this article: Echeverria-Villalobos M, Munlemvo DM, Fiorda-Diaz J, Essandoh MK. Mechanical ventilation and
cardiopulmonary bypass: a narrative review of the mechanistic lung protective measures. Vessel Plus 2019;3:33.
http://dx.doi.org/10.20517/2574-1209.2019.12

Received: 19 Apr 2019 First Decision: 9 Aug 2019 Revised: 9 Aug 2019 Accepted: 13 Aug 2019 Published: 17 Sep 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Jia-Jia Meng Production Editor: Tian Zhang

Abstract
Postoperative pulmonary dysfunction is a multifactorial complication in patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB). Numerous risk factors including individual, surgery- and anesthesia-related have been
identified. Exacerbated systemic and pulmonary inflammatory response to CPB is one of the most studied mechanisms
of lung injury in this patient setting. However, current literature lacks specific intraoperative mechanical ventilation (MV)
strategies associated with a significant improvement in patients’ outcomes. We reviewed the randomized clinical trials
and other reports published within the last 5 years involving patients undergoing cardiac surgery with CPB in order to
summarize the existing MV strategies used in these patients and their associated outcomes. Moreover, we described the
pathophysiological mechanisms involved in post- CPB lung injury and the mechanistic effects of protective ventilation.

Keywords: Cardiopulmonary bypass, mechanical ventilation, postoperative pulmonary complications, protective mechanical
ventilation

INTRODUCTION
Impaired postoperative pulmonary function is a common and multifactorial complication after cardiac
surgery [1,2] . Exacerbated cellular and humoral activation is a widely-known response ensuing from
cardiopulmonary bypass (CPB), being the major cause of postoperative lung injury [3,4] . Protective

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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