The Effect of Transport Manual and Mechanical Ventilation on Hemodynamics Change: Randomized Clinical Trial.

Abstract

Background: Ventilation methods during ICU transport after cardiac surgery are critical. This study aimed to assess the effects of manual and mechanical ventilation on post-transport hypotension in patients undergoing cardiac surgery. Methods: This prospective clinical trial was conducted at a tertiary academic hospital. Adult patients who underwent open heart surgery were randomized to either (1) manual ventilation or (2) mechanical ventilation during transport. The primary outcomes were the hemodynamic parameters change. The secondary outcomes were the PaO2/FiO2 ratio and PaCO2 change. Results: A total of 78 patients were randomized into two groups: manual ventilation (n = 39) and mechanical ventilation (n = 39). Significant hypotension (>20% drop in mean arterial pressure post-transport) was noted in nine patients in the manual ventilation arm, but not in any patient in the mechanical ventilation arm. In manually ventilated patients, receiver operating characteristic curve analysis of systemic vascular resistance for significant hypotension showed that the area under the curve was 0.962 (95% CI, 0.891-1). No mechanically ventilated patients had significant hypotension. No significant difference was observed in % change in PaO2 and PaCO2 between the manual and mechanical ventilation arms. Conclusion: This study demonstrated that significant post-transport hypotension was more common in the manually ventilated arm than in the mechanically ventilated arm. No significant differences in oxygenation or ventilation were observed between the groups. The low systemic vascular resistance showed excellent predictive value for significant post-transport hypotension. Further research is warranted to identify patient-specific risk factors to enhance transportation safety.