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October 1, 2025BMJ OpenOpen Access

Impact of intraoperatiVe moderAte positive end-expiratory pressure with reCruitment mAnoeuvres versus low positive end-expiRatory pressure on major postoperative pulMonary complications and death after on-pump cardiac surgery in high-risk patients: the VACARM randomised clinical trial-study protocol

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Authors

NDNathalie DemaureInserm JCJehanne Le CunffInserm MDM DuchêneCentre Hospitalier Universitaire de Nantes

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Implication

Randomized trial reports protocol evaluating postoperative pulmonary complications in cardiac surgery, highlighting strategies to optimize mechanical ventilation.

Key Points

To determine whether intraoperative moderate positive end-expiratory pressure combined with recruitment manoeuvres reduces major postoperative pulmonary complications and mortality compared to low positive end-expiratory pressure without recruitment manoeuvres in high-risk cardiac surgery patients.
Multicentre, open-label, randomized, parallel-group superiority clinical trial (ClinicalTrials.gov NCT04408495) initiated in July 2021.
Elective on-pump cardiac surgery patients at risk of pulmonary complications are randomized to an open-lung strategy (moderate positive end-expiratory pressure plus recruitment manoeuvres) or standard protective ventilation (low positive end-expiratory pressure without recruitment manoeuvres).
The primary composite outcome evaluates prolonged mechanical ventilation (>24 hours), reintubation, hospital-acquired pneumonia within 7 days, or all-cause mortality within 28 days post-surgery, analyzed by intention-to-treat.
The trial protocol outlines prospective evaluation of a composite endpoint spanning 7-day pulmonary events and 28-day mortality, with outcome data pending study completion.
Recruitment commenced across participating surgical centers to establish whether an open-lung ventilation strategy provides superior clinical protection over standard low-pressure settings.

Cite This Study

Demaure et al. (2025) studied this question.

synapsesocial.com/papers/6aaf3fe784c19a519ba5f25d https://doi.org/10.1136/bmjopen-2025-104179

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Implication

Randomized trial reports protocol evaluating postoperative pulmonary complications in cardiac surgery, highlighting strategies to optimize mechanical ventilation.

Impact of intraoperatiVe moderAte positive end-expiratory pressure with reCruitment mAnoeuvres versus low positive end-expiRatory pressure on major postoperative pulMonary complications and death after on-pump cardiac surgery in high-risk patients: the VACARM randomised clinical trial-study protocol

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Cite This Study

Impact of intraoperatiVe moderAte positive end-expiratory pressure with reCruitment mAnoeuvres versus low positive end-expiRatory pressure on major postoperative pulMonary complications and death after on-pump cardiac surgery in high-risk patients: the VACARM randomised clinical trial-study protocol

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