Impact of Ventilation Discontinuation During Cardiopulmonary Bypass: A Prospective Observational Study

Li T. Zhailauova A. Wachruschew I. Kuanyshbek A. Tulegenov S. Bukirova P. Zhakupbekov B. Nikitin I. Ayaganov D. Kapyshev T. Samalavicius R. Melnikov A.L. Aslanidis T.
November 2025 Multidisciplinary Digital Publishing Institute (MDPI)

Journal of Clinical Medicine
2025 #14 Issue 22

Background: Discontinuing mechanical ventilation during cardiopulmonary bypass (CPB) is common but may adversely affect postoperative pulmonary function. This study aimed to evaluate the impact of stopping ventilation during CPB on postoperative gas exchange, radiographic findings, intensive care unit (ICU) length of stay (LOS), mortality, reintubation, re-exploration, and bleeding. Methods: A prospective observational study was performed involving adult patients scheduled for elective cardiac surgery requiring CPB. Participants were divided into ventilated and non-ventilated groups according to intraoperative strategy. Postoperative arterial carbon dioxide levels (PaCO₂), arterial partial pressure of oxygen (PaO₂), the PaO₂/FiO₂ ratio (P/F ratio), arterial oxygen saturation (SaO₂), and the ratio of PaCO₂ to minute ventilation (PaCO₂/MV) were measured before the induction of anesthesia (within 5 min after transportation into the operating room), postoperatively within 5–10 min after transportation to the ICU, and in a 24 h postoperative period. Chest X-ray data, mechanical ventilation time, LOS in ICU, re-exploration, reintubation, and bleeding parameters were documented. Analyses were also conducted with the estimation of the age effect and BMI. Results: Individuals in the non-ventilated group exhibited lower postoperative P/F ratios and elevated postoperative PaCO₂ and PaCO₂/MV ratios. The difference in gas exchange leveled off within 24 h. There was no difference in the incidence of atelectasis (postoperatively in a 24 h period), mechanical ventilation time, LOS in ICU, or mortality. However, the incidence of bleeding was higher in the non-ventilated group (χ² = 5.78, p = 0.016). Interestingly, postoperative PaCO₂ and PaCO₂/MV peaked in the 50-year age group. Conclusions: Continued mechanical ventilation during CPB correlates with better postoperative gas exchange, better CO₂ clearance, and fewer bleeding events. The results suggest that maintaining low tidal volume ventilation during CPB may provide benefits, especially for patients aged 50 years.

cardiac surgery , cardiopulmonary bypass CPB , mechanical ventilation

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Department of Anesthesia and Intensive Care, Heart Center CF “University Medical Center”, Astana, 010000, Kazakhstan
Department of Surgery, Nazarbayev University School of Medicine, Astana, 010000, Kazakhstan
Clinic of Emergency Medicine, Vilnius University, Vilnius, LT-03101, Lithuania
Department of Anesthesiology and Intensive Care, Vestre Viken Hospital Trust, Ringerike Hospital, Hønefoss, 3511, Norway
Intensive Care Unit & Anesthesia Department, Agios Pavlos General, Hospital of Thessaloniki, Thessaloniki, 55135, Greece

Department of Anesthesia and Intensive Care
Department of Surgery
Clinic of Emergency Medicine
Department of Anesthesiology and Intensive Care
Intensive Care Unit & Anesthesia Department

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