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

Koner 2004.

Methods RCT with parallel groups
Approved by the ethics committee and written informed consents obtained
Site: Cardiology Institute, Istanbul University, Haseki caddesi, Aksaray‐Istanbul, Turkey
Setting: university hospital
Dates of data collection: November 2001 to August 2002
Participants 44 adults undergoing coronary artery bypass graft
Exclusion criteria: acute infections, pre‐existing pulmonary disease, left ventricular ejection fraction < 40%, myocardial infarction within 1 month, reoperation, coagulopathy, unstable angina pectoris and renal failure
Interventions Treatment group: tidal volume 6 mL/kg, respiratory rate: 15 breaths/min and PEEP 5 cmH2O (n = 15)
Control groups:

  1. tidal volume 10 mL/kg, respiratory rate: 9 breaths/min, PEEP 5 cmH2O, (n = 14)

  2. tidal volume 10 mL/kg, respiratory rate: 9 breaths/min, no PEEP (n = 15)


Before discontinuation of CPB, the lungs were inflated manually up to 40 cmH2O peak airway pressure for 20 seconds and the ventilation was started with a FiO2 of 0.6 then reduced to 0.5. Corticosteroids, antifibrinolytic agents or aprotinin were not used and no ultrafiltration technique was employed throughout the study.
Outcomes Relevant to this review

  1. Invasive ventilatory support

  2. Hospital length of stay

  3. Mortality at 30 days (during hospital length of stay and mean hospital length of stay: mean 7.9 (SD 1.2) days)


Others

  1. Tumour necrosis factor α

  2. Interleukin‐6

  3. Plateau airway pressure, shunt, oxygenation, alveolo‐arterial oxygen difference
Notes Funding: partially supported by Fresenius‐Kabi and Aventis Pharma
Declaration of interest: partially supported by Fresenius‐Kabi and Aventis Pharma
The treatment group was split in half to compare with each control group.
As no other recruitment manoeuvre was mentioned apart from the 1 single reinflation manoeuvre just before ending CPB, for heterogeneity exploration, participants were considered as not having received recruitment manoeuvres during surgery.
Volume per body weight: IBW, no further details
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "randomized;" no details
Allocation concealment (selection bias) Low risk Quote: "following the anaesthesia induction, patients were randomized."
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Quote: "anaesthesia and intensive care unit teams were not blinded."
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