Lung Protective Ventilation and Driving Pressure Guided PEEP Titration in CABG Surgery

The primary goal of the researchers: To compare the effects of fixed PEEP versus driving pressure guided individualized PEEP in lung protective mechanical ventilation during on-pump open heart surgery effect of PaO2/ FiO2 ratio end of surgery.

The secondary goals of the researchers: To compare intraoperative hemodynamics, lung compliance and airway pressures, extubation time and respiratory complications [development of atelectasis, need for noninvasive mechanical ventilation (high-flow nasal cannula or CPAP application), need for re-intubation], length of stay in the ICU and discharge times.

Inclusion criteria

• Patients scheduled for elective on-pump coronary artery bypass graft surgery via median sternotomy
• Patients between the ages of 18 and 70
• ASA (American Society of Anesthesiologists) physical status classification II-III

Exclusion criteria

• Patients with an ejection fraction below 35%
• Patients who did not consent to participate in the study
• Patients undergoing emergency surgery
• Patients who are allergic to the anesthetic drugs used
• Patients who have undergone lung resection
• Those with a history of mechanical ventilation in the 2 months before surgery
• Patients who have undergone total circulatory arrest and deep hypothermia
• Patients with obstructive sleep apnea syndrome requiring long-term ventilation assistance
• Morbid obesity (Body Mass Index>35kg/m2)
• Patients with refractory hypoxemia (arterial oxygen saturation below 88% despite 100% oxygen inhalation)
• COPD (FEV1<70%)
• Patients with chronic renal failure (serum creatine>1.8 mg/dl)
• Anemia (Hg<10 gr/dl)
• Patients who have had an intraaortic balloon pump placed.