Fixed versus personalized PEEP for lung protection during heart bypass surgery

Comparison of Individualized PEEP Application Versus Fixed PEEP Application for Lung-Protective Ventilation in Patients Undergoing On-Pump Coronary Artery Bypass Grafting Surgery

This test will compare a standard fixed PEEP setting with a personalized, driving-pressure guided PEEP for adults having on-pump coronary artery bypass surgery to see which better protects the lungs and breathing after surgery.

Quick facts

• Study type: Observational
• Enrollment: 86 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: Kocaeli University (Academic / other)
• Locations: 1 site (Kocaeli, izmit)
• Trial ID: NCT07044089 on ClinicalTrials.gov

What this trial studies

This single-center observational comparison will apply lung-protective ventilation with either a fixed PEEP or a driving-pressure guided individualized PEEP during elective on-pump CABG procedures. The primary outcome is oxygenation measured by the PaO2/FiO2 ratio at the end of surgery. Secondary outcomes include intraoperative hemodynamics, respiratory mechanics (lung compliance and airway pressures), extubation time, postoperative respiratory complications (atelectasis, need for noninvasive ventilation, need for re‑intubation), ICU length of stay, and discharge timing. Adult patients meeting ASA II-III criteria and other inclusion/exclusion rules will be enrolled and followed through their immediate postoperative course.

Who should consider this trial

Good fit: Adults aged 18–70 scheduled for elective on-pump coronary artery bypass grafting with ASA physical status II–III and without major cardiac, pulmonary, renal, or other exclusion conditions are the intended candidates.

Not a fit: Patients with severe cardiac dysfunction (EF <35%), recent mechanical ventilation, morbid obesity, severe COPD, chronic renal failure, emergency surgery, or other listed exclusions are unlikely to be eligible or to benefit from the interventions tested.

Why it matters

Potential benefit: If successful, personalized driving-pressure guided PEEP could improve oxygenation and reduce postoperative respiratory complications, shorten time on ventilator, and decrease ICU stay.

How similar studies have performed: Prior trials in critical care and noncardiac surgery have shown that individualized PEEP or driving-pressure guided ventilation can improve oxygenation and mechanics, but evidence specifically in on-pump cardiac surgery remains limited.

Eligibility criteria

Inclusion Criteria:

* Patients scheduled for elective on-pump coronary artery bypass graft surgery via median sternotomy
* Patients between the ages of 18 and 70
* ASA (American Society of Anesthesiologists) physical status classification II-III

Exclusion Criteria:

* Patients with an ejection fraction below 35%
* Patients who did not consent to participate in the study
* Patients undergoing emergency surgery
* Patients who are allergic to the anesthetic drugs used
* Patients who have undergone lung resection
* Those with a history of mechanical ventilation in the 2 months before surgery
* Patients who have undergone total circulatory arrest and deep hypothermia
* Patients with obstructive sleep apnea syndrome requiring long-term ventilation assistance
* Morbid obesity (Body Mass Index\>35kg/m2)
* Patients with refractory hypoxemia (arterial oxygen saturation below 88% despite 100% oxygen inhalation)
* COPD (FEV1\<70%)
* Patients with chronic renal failure (serum creatine\>1.8 mg/dl)
* Anemia (Hg\<10 gr/dl)
* Patients who have had an intraaortic balloon pump placed.

Where this trial is running

Kocaeli, izmit

• Kocaeli University Faculty of Medicine — Kocaeli, izmit, Turkey (Türkiye) (Recruiting)

Study contacts

• Study coordinator: Zeynep Açık, MD

Conditions Peep Titration in Lung Protective Ventilation; Lung Protective Ventilation; Fixed PEEP; Individualized PEEP