Use of positive end-expiratory pressure (20 cmH₂O) for 60 s during elective heart surgery: A randomized clinical trial

Background: Although lung expansion therapy with positive end-expiratory pressure (PEEP) following heart surgery is associated with positive clinical outcomes, whether such therapy can improve oxygenation and diminish the occurrence of lung complications when performed during heart surgery with extracorporeal circulation (ECC) is not yet clear. Objective: Analyze the impact of lung expansion therapy with PEEP at 20 cmH(2)O for 60 s during elective heart surgery. Methods: A randomized clinical trial was conducted. The experimental group (EG) (n = 27) received PEEP at 20 cmH(2)O for 60 s during heart surgery at the moment in which ECC was ended. No intraoperative maneuver was performed in the control group (CG) (n = 15). Results: The incidence of atelectasis upon hospitalization and the pre-maneuver oxygenation index (PaO2/FiO(2)) were similar between the groups. A lower incidence of atelectasis in the immediate postoperative period (7.4%, p = 0.03) and shorter time on noninvasive mechanical ventilation (T-NIMV) (5.78 +/- 2.54, p = 0.01) were found in the EG compared with the CG. Conclusions: The application of PEEP at 20 cmH(2)O for 60 s during heart surgery reduces the incidence of atelectasis in the immediate postoperative period and shortens the T-NIMV. This maneuver proved to be safe, with no adverse events.