Prophylactic Use of APRV Before Extubation in Morbidly Obese Patients After Cardiac Surgery.

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Conditions studied: Morbid Obesity in Cardiac Surgery Patients, Postoperative Respiratory Dysfunction, Mechanical Ventilation Strategies

In brief

Morbidly obese patients undergoing open heart surgery are at increased risk of breathing problems after removal of the breathing tube due to reduced lung function and chest wall restriction following surgery. These complications may result in poor oxygenation, respiratory failure, and prolonged ICU stay. Airway Pressure Release Ventilation (APRV) is a mechanical ventilation mode that improves lung recruitment and oxygenation. This study aims to evaluate whether the prophylactic use of APRV after ICU admission, compared with conventional lung-protective mechanical ventilation, improves oxygenation, lung function, and ICU outcomes in morbidly obese patients undergoing elective cardiac surgery. Patients will be randomly assigned to receive either APRV or conventional ventilation during postoperative mechanical ventilation, followed by standard weaning and extubation. Outcomes include oxygenation index, lung ultrasound findings, need for reintubation, and ICU clinical outcomes.

Key facts

Study ID

NCT07409324

Run by

Ain Shams University

People needed

180

Starts

2026-02-01

Expected to finish

2026-11-01

Last updated by the study team

2026-02-13

Who can join

Age: 18 and older, up to 65. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Adult patients aged 18-65 year of both sex.
• Morbidly obese patients (body mass index ≥ 40 kg/m² or ≥ 35 kg/m² with obesity-related comorbidities)
• Scheduled for elective cardiac surgery (CABG, valve, or combined) requiring cardiopulmonary bypass
• Planned postoperative admission to the cardiac surgical intensive care unit
• Patients eligible for mechanical ventilation with planned early extubation within 6-12 hours postoperatively
• Ability to provide written informed consent

You may not qualify if…

• Severe pulmonary disease (e.g., COPD GOLD III/IV, home oxygen therapy, and pulmonary fibrosis).
• Patients with history of previous spontaneous pneumothorax or postoperative pneumothorax.
• Intracranial hypertension or contraindication to APRV. Hemodynamically unstable on admission (MAP less than 65 mmHg) Vasopressor/inotropic score (VIS) more than 10 Requirement for postoperative extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP).
• Inability to obtain informed consent

Full record on ClinicalTrials.gov

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