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. 2018 Jul 9;2018(7):CD011151. doi: 10.1002/14651858.CD011151.pub3

Chaney 2000.

Methods RCT with parallel groups
Institutional review board approval and informed consents obtained
Site: Loyola University Medical Center
Setting: university hospital
Dates of data collection: unspecified
Participants 25 participants scheduled for elective coronary artery bypass graft surgery and early tracheal extubation
Exclusion criteria: previous lung surgery or who required preoperative mechanical ventilation
Interventions Treatment group: tidal volume 6 mL/kg; FiO2 1.0; respiratory rate 16 breaths/min; and
 PEEP 5, after tracheal intubation (n = 12)
Control group: tidal volume 12 mL/kg; respiratory rate 8 breaths/min; FiO2 1.0; and PEEP 5 cmH2O, after tracheal intubation (n = 13)
In both groups, the inspiratory/expiratory ratio was 1:3, and the inspiratory flow was adjusted so that the calculated tidal volume was delivered during the entire inspiratory cycle (creating the lowest peak airway pressure). Each mode of ventilation (conventional or protective) was used during the entire intraoperative period and during the first hour after arrival in the ICU. After 1 hour following ICU arrival (and after last data collection time), all participants received mechanical ventilation parameters of respiratory rate 10 breaths/min; tidal volume 8 mL/kg; FiO2 1.0 and PEEP 15, and were weaned from mechanical ventilation according to the normal ICU protocol. Criteria for extubation in the ICU at this institution included an appropriate sensorium, normothermia, haemodynamic stability, adequate pulmonary function (PaO2 > 60 mmHg with a FiO2 0.4), adequate urine output and minimal chest tube output.
Outcomes Relevant to this review

  1. Need for invasive ventilatory support

  2. Hospital length of stay

  3. Mortality at 7 and 30 days (during hospital stay: mean hospital length of stay 5.9 (SD 3.9) and 10.8 (SD 12.9) days)


Others

  1. Mean postoperative increase in peak inspiratory pressure

  2. Mean postoperative increase in plateau inspiratory pressure

  3. Mean postoperative decrease in dynamic lung compliance

  4. Mean postoperative decrease in static lung compliance

  5. Mean postoperative shunt
Notes Funding: supported by Loyola University Medical Center, Department of Anesthesiology, Research Fund
Declaration of interest: none mentioned
Postoperative complications and treatments were recorded daily until hospital discharge
Volume per body weight: method used to determine body weight unspecified
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "each patient was randomized to one of two groups by a random numbers table."
Allocation concealment (selection bias) Unclear risk Quote: "before arriving in the operating room"; no other details.
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Not mentioned
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Not mentioned
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No loss to follow‐up
Selective reporting (reporting bias) Low risk All results reported
Other bias Low risk Groups well balanced