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Table 2 Perioperative ventilatory protocol in each of the two treatment arms

From: A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

  Conventional ventilation Open-lung ventilation
Ventilation before CPB • Tidal volume 6–8 mL/kg PBW
• PEEP 2 cmH2O
• RR for ETCO2 35–45 mmHg
• Lowest FiO2 to maintain SpO2 > 94%.
• I:E ratio at 1:2
• Tidal volume 6–8 mL/kg PBW
• PEEP 8 cmH2O
• RR for ETCO2 35–45 mmHg
• Lowest FiO2 to maintain SpO2 > 94%
• I:E ratio at 1:2
Systematic recruitment maneuvers No Yes
Ventilation during CPB CPAP 2 cmH2O Ultraprotective ventilation
• Tidal volume 3 mL/kg PBW
• PEEP 8 cmH2O
• RR 12 cpm
• FiO2 40%
Ventilation after CPB
(including in ICU)
• Tidal volume 6–8 mL/kg PBW
• PEEP 2 cmH2O
• RR for ETCO2 35––45 mmHg
• Lowest FiO2 to maintain SpO2 > 94%
• I:E ratio at 1:2
• Tidal volume 6–8 mL/kg PBW
• PEEP 8 cmH2O
• RR for ETCO2 35––45 mmHg
• Lowest FiO2 to maintain SpO2 > 94%
• I:E ratio at 1:2
Protocol deviation Rescue strategy
• Unplanned recruitment maneuver
• +/− PEEP increase
Surgical or hemodynamic deviation
• Recruitment maneuver interruption
• PEEP decrease (1 cmH2O by 1 cmH2O step)
  1. CPB cardiopulmonary bypass, CPAP continuous positive airway pressure, FiO2 inspired oxygen fraction, I:E inspiratory time to expiratory time ratio, PEEP positive end-expiratory pressure, PBW predicted body weight, RR respiratory rate, SpO2 pulse oximetry, ETCO2 end-tidal CO2