Single-step vs Stepwise Lung Recruitment Maneuvers After Cardiopulmonary Bypass
Comparison of Hemodynamic and Pulmonary Outcomes Between Single-Step and Stepwise Lung Recruitment Maneuvers After Cardiopulmonary Bypass: A Randomized Controlled Trial
Ondokuz Mayıs University
52 participants
Feb 15, 2026
INTERVENTIONAL
Conditions
Summary
This prospective randomized controlled trial aims to compare the hemodynamic and pulmonary effects of single-step and stepwise lung recruitment maneuvers in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. After separation from cardiopulmonary bypass, patients will be randomized to receive either a single-step sustained inflation recruitment maneuver or a stepwise incremental recruitment maneuver, both combined with 8 cmH₂O positive end-expiratory pressure. The primary outcome is the change in cardiac index before and after the recruitment maneuver. Secondary outcomes include lung ultrasound atelectasis score, and hemodynamic parameters.
Eligibility
Inclusion Criteria3
- Age 18-80 years
- ASA (American Society of Anesthesiologists) II-IV
- Patients undergoing elective cardiac surgery (coronary artery bypass grafting, mitral valve replacement, aortic valve replacement)
Exclusion Criteria12
- Emergency surgery
- Presence of perioperative arrhythmia
- <35% left ventricular ejection fraction
- >50 mmHg systolic pulmonary artery pressure
- Known chronic obstructive pulmonary disease or interstitial lung disease
- Pneumothorax
- Mean arterial pressure <60 mmHg during recruitment maneuver
- New York Heart Association (NYHA) class III-IV heart failure
- Advanced cardiomyopathy or severe mitral regurgitation
- Cross-clamp time longer than 2 hours
- Requirement for high-dose inotropic or vasopressor support
- Patients who cannot be extubated after postoperative 24 hours
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Interventions
A sustained inflation lung recruitment maneuver with an airway pressure of 30 cmH₂O applied for 30 seconds after separation from cardiopulmonary bypass, combined with 8 cmH₂O positive end-expiratory pressure.
A stepwise lung recruitment maneuver in which airway pressure is increased by 5 cmH₂O every 5 seconds up to 30 cmH₂O and then decreased in the same manner after separation from cardiopulmonary bypass, combined with 8 cmH₂O positive end-expiratory pressure.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT07432477