VECAR
Trial question
What is the role of maintaining very low tidal volume ventilation with PEEP in patients undergoing scheduled cardiac surgery with cardiopulmonary bypass?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
22.0% female
78.0% male
N = 1362
1362 patients (297 female, 1065 male).
Inclusion criteria: adult patients undergoing scheduled cardiac surgery with cardiopulmonary bypass.
Key exclusion criteria: emergency surgery; planned thoracotomy with one-lung ventilation; known respiratory diseases; intubation in the perioperative period; immunosuppression; need for vasopressor or inotropic agents before surgery; acute infection in the last month before surgery; HF with LVEF < 35%; incarceration.
Interventions
N=682 mechanical ventilation (maintaining very low tidal volume of 2.5 mL/kg ventilation with PEEP of 5-7 cmH₂O).
N=680 no ventilation (tracheal tube disconnected from the ventilator).
Primary outcome
Rate of postoperative infections within the first 28 days after surgery
10%
10.9%
10.9 %
8.2 %
5.5 %
2.7 %
0.0 %
Mechanical
ventilation
No
ventilation
No significant
difference ↔
No significant difference in the rate of postoperative infections within the first 28 days after surgery (10% vs. 10.9%; RR 0.92, 95% CI 0.67 to 1.25).
Secondary outcomes
Significant increase in the number of days of antibiotics (212 per 1,000 days of hospitalization vs. 196 per 1,000 days of hospitalization; IRR 1.08, 95% CI 1.02 to 1.15).
No significant difference in duration of mechanical ventilation (550 minutes vs. 555 minutes; MD -5, 95% CI -23 to 15).
No significant difference in pressure of arterial oxygen to fractional inspired concentration ratio at day 1 (313 mmHg vs. 310 mmHg; MD 3.1, 95% CI -9 to 15.3).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In adult patients undergoing scheduled cardiac surgery with cardiopulmonary bypass, mechanical ventilation was not superior to no ventilation with respect to the rate of postoperative infections within the first 28 days after surgery.
Reference
Jean-Marc Tadié, Alexandre Ouattara, Bruno Laviolle et al. Maintaining ventilation with very low tidal volume and positive-end expiratory pressure versus no ventilation during cardiopulmonary bypass for cardiac surgery in adults: a randomized clinical trial. Intensive Care Med. 2025 May 5. Online ahead of print.
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