Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Effect of mechanical ventilation during cardiopulmonary bypass on oxidative stress: a randomized clinical trial

Yavuz Orak; Filiz Alkan Baylan; Aydemir Kocaslan; Erdinc Eroglu; Mehmet Acipayam; Mehmet Kirisci; Omer Faruk Boran; Adem Doganer

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Cardiopulmonary bypass (CPB) causes systemic oxidative stress response and endothelial damage in systemic organs. We investigated the effects of positive end-expiratory pressure (PEEP) and mechanical ventilation (MV) applications on oxidative stress in CPB.

Seventy-one patients were recruited and 60 completed the study. Randomized groups: MV off (Group 1); MV on, tidal volume (TV) at 3–4 (Group 2); MV on, TV at 3–4, PEEP at 5 cmH2O (Group 3), n = 20 in each group. As oxidative stress markers, we used glutathione peroxidase (GPx), total antioxidant status (TAS), total oxidant status (TOS), total and native thiol (TT, NT), malondialdehyde (MDA), and catalase. We also investigated the correlation between oxidative stress and postoperative intubation time.

The postoperative GPx levels in Group 2 were higher than Group 3 (p = 0.017). In groups 2 and 3, TAS levels were higher postoperatively than intraoperatively (p = 0.001, p = 0.019, respectively). In Group 2, the TT levels were higher postoperatively than preoperatively and intraoperatively (p = 0.008). In Group 3, the postoperative MDA levels were higher than preoperatively (p = 0.001) and were higher than both postoperative levels of Group 1 and 2 (p = 0.043, p = 0.003). As the preoperative TAS (Group 2) decreased and the postoperative NT (Group 2) and catalase (Group 3) increased, the postoperative intubation time lengthened.

MV ( 3–4 alone seems to be the most advantageous strategy. Prolonged postoperative intubation time was associated with both increased NT and catalase levels.


Oxidative stress;  Peep;  Tidal volume;  Cardiopulmonary bypass


1 C. Baufreton, J.J. Corbeau, F. Pinaud Inflammatory response and haematological disorders in cardiac surgery: toward a more physiological cardiopulmonary bypass Ann Fr Anesth Reanim, 25 (2006), pp. 510-520

2 A. Dabbous, C. Kassas, A. Baraka The inflammatory response after cardiac surgery Middle East J Anaesthesiol, 17 (2003), pp. 233-254

3 J.K. Kirklin, D.C. McGiffin Early complications following cardiac surgery Cardiovasc Clin, 17 (1987), pp. 321-343

4 N. Allou, R. Bronchard, J. Guglielminotti, et al. Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score Crit Care Med, 42 (2014), pp. 1150-1156

5 E. Bignami, M. Guarnieri, F. Saglietti, et al. Different strategies for mechanical ventilation during Cardiopulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial Trials, 18 (2017), p. 264

6 C. Ferrando, M. Soro, F.J. Belda Protection strategies during cardiopulmonary bypass: ventilation, anesthetics and oxygen Curr Opin Anaesthesiol, 28 (2015), pp. 73-80

7 T.A. Pearson, G.A. Mensah, R.W. Alexander, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the centers for disease control and prevention and the American Heart Association Circulation, 107 (2003) 499–11

8 M. García-Delgado, I. Navarrete Sanchez, M. Colmenero Preventing and managing perioperative pulmonary complications following cardiac surgery Curr Opin Anesthesiol, 27 (2014), pp. 146-152

9 S.N. Hemmes, A. Serpa Neto, M.J. Schultz Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis Curr Opin Anesthesiol, 26 (2013), pp. 126-133

10 M.A. Chaney, M.P. Nikolov, B.P. Blakeman, et al. Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass J Cardiothorac Vasc Anesth, 14 (2000), pp. 514-518

11 O. Koner, S. Celebi, H. Balci, et al. Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass Intensive Care Med, 30 (2004), pp. 620-626

12 E. Zupancich, D. Paparella, F. Turani, et al. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: a randomized clinical trial J Thorac Cardiovasc Surg, 130 (2005), pp. 378-383

13 R. Bolli Oxygen-derived free radicals and myocardial reperfusion injury: an overview Cardiovasc Drugs Ther, 5 (1991), pp. 249-268

14 C. Han, W. Ding, W. Jiang, et al. A comparison of the effects of midazolam, propofol, and dexmedetomidine on the antioxidant system: a randomized trial Exp Ther Med, 9 (2015), pp. 2293-2298

15 U. Mentese, O.V. Dogan, I. Turan, et al. Oxidant-antioxidant balance during on-pump coronary artery bypass grafting Sci World J, 2014 (2014), Article 263058

16 C. Berndt, C.H. Lillig, A. Holmgren Thiol-based mechanisms of the thioredoxin and glutaredoxin systems: implications for diseases in the cardiovascular system Am J Physiol Heart Circ Physiol, 292 (2007), pp. 1227-1236

17 H. Ohkawa, N. Ohishi, K. Yagi Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction Anal Biochem, 95 (1979), pp. 351-358

18 E. Beutler Red cell metabolism. A manual of biochemical methods (2nd ed), Grune and Strattan Company, New York (1975), pp. 67-69

19 E. Beutler Red cell metabolism. A manual of biochemical methods (2nd ed), Grune and Stratton Company, New York (1975) 261–5.15. Shimadzu UV. Spectro photometer-UV 1800. Japan

20 Shimadzu UV – Spectro photometer-UV 1800. Japan.

21 O. Erel, S. Neselioglu A novel and automated assay for thiol/disulphide homeostasis Clin Biochem, 47 (2014), pp. 326-332

22 A. Koçarslan, A. Hazar, M.S. Aydın, et al. Koroner bypass ameliyatı öncesi trimetazidin kullanımının oksidatif parametreler üzerine etkileri Dicle Tıp Dergisi, 40 (2013), pp. 589-596

23 L. Hadjinikolaou, C. Alexiou, A.S. Cohen, et al. Early changes in plasma antioxidant and lipid peroxidation levels following coronary artery bypass surgery: a complex response Eur J Cardiothorac Surg, 23 (2003), pp. 969-975

24 C.R. Luyten, F.J. van Overveld, L.A. De Backer, et al. Antioxidant defence during cardiopulmonary bypass surgery Eur J Cardiothorac Surg, 27 (2005), pp. 611-616

25 A. Arduini, A. Mezzet, E. Porecca, et al. Effect of ischemia reperfusion on antioxidant enzymes and mitochondrial inner membrane proteins in perfused rat heart Biochim Biophys Acta, 970 (1988), pp. 113-121

26 M. Inal, O. Alatas, G. Kanbak, et al. Changes of antioxidant enzyme activities during cardiopulmonary bypass J Cardiothorac Surg, 40 (1999), pp. 373-376

27 A. Dogan, F.S. Turker The effect of on-pump and off-pump bypass operations on oxidative damage and antioxidant parameters Oxid Med Cell Longev, 2017 (2017), Article 8271376

28 B.M. Matata, A.W. Sosnowski, M. Galiñanes Off-pump bypass graft operation significantly reduces oxidative stress and inflammation Ann Thorac Surg, 69 (2000), pp. 785-791

29 S.E. Ozgunay, K.K. Ozsin, Y. Ustundag, et al. The effect of continuous ventilation on thiol-disulphide homeostasis and albumin-adjusted ischemia-modified albumin during cardiopulmonary bypass Braz J Cardiovasc Surg, 34 (2019), pp. 436-443

30 J. García-de-la-Asunción, E. Pastor, J. Perez-Griera, et al. Oxidative stress injury after on-pump cardiac surgery: effects of aortic cross-clamp time and type of surgery Red Rep, 18 (2013), pp. 193-199

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