{
  "abstract": "Introduction Postoperative pulmonary complications (PPCs) are common after cardiac surgery and are associated with significant morbidity and mortality. Lung-protective ventilation strategies have been proposed to reduce PPCs, but the optimal level of positive end-expiratory pressure (PEEP) and the use of alveolar recruitment manoeuvres (RMs) remain controversial.Methods/analysis In this investigator-initiated, multicentre, open, randomised, parallel-group, superiority clinical trial, elective cardiac surgery patients at risk of PPCs will be assigned to one of two intraoperative ventilation strategies: (1) an open-lung ventilation strategy with protective ventilation, moderate PEEP and RMs or (2) a standard protective ventilation with low PEEP and no RM. The primary outcome will be a composite of prolonged (>24 hour) postoperative mechanical ventilation, reintubation for any cause or hospital-acquired pneumonia within 7 days of surgery, or death within 28 days of surgery. Data will be analysed on an intention-to-treat basis.Ethics and dissemination The VACARM (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) trial has been approved by an independent ethics committee for all study centres. Recruitment began in July 2021. Results will be published in international peer-reviewed medical journals.Trial registration number ClinicalTrials.gov NCT04408495.",
  "authors": [
    {
      "affiliations": [
        "Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Department of Anesthesia and Critical Care, Pontchaillou, Rennes University Hospital, Rennes, Brittany, France"
      ],
      "name": "Nathalie Demaure"
    },
    {
      "affiliations": [
        "Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Department of Anesthesia and Critical Care, Pontchaillou, Rennes University Hospital, Rennes, Brittany, France"
      ],
      "name": "Jehanne Le Cunff"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, University Hospital Centre Nantes, Nantes, Pays de la Loire, France"
      ],
      "name": "Maryline Duchêne"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes and Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, University Hospital Centre Nantes, Nantes, Pays de la Loire, France"
      ],
      "name": "Bertrand Rozec"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France"
      ],
      "name": "Fabien Espitalier"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, CHU de Brest, Brest, Brittany, France"
      ],
      "name": "Jean-Michel Cabon"
    },
    {
      "affiliations": [
        "Département d’Anesthésie et Réanimation Chirurgicale, Brest University Hospital Centre, Brest, Brittany, France"
      ],
      "name": "Jean-Ferréol Oilleau"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, CHU de Nancy, Nancy, Lorraine, France"
      ],
      "name": "Philippe Guerci"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France"
      ],
      "name": "François Labaste"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, Amiens-Picardy University Hospital, Amiens, Hauts-de-France, France"
      ],
      "name": "Osama Abou-Arab"
    },
    {
      "affiliations": [
        "Burgundy Franche-Comté University, Besancon, France"
      ],
      "name": "Pierre-Grégoire Guinot"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, University Hospital Centre Rouen, Rouen, Normandy, France"
      ],
      "name": "Pierre Duval"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Critical Care, University Hospital Centre Rouen, Rouen, Normandy, France"
      ],
      "name": "Emmanuel Besnier"
    },
    {
      "affiliations": [
        "Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France"
      ],
      "name": "Erwan Flécher"
    },
    {
      "affiliations": [
        "Univ Rennes, CHU de Rennes, Department of Research and Innovation, University Hospital of Rennes, Rennes University Hospital, Rennes, Brittany, France"
      ],
      "name": "Isabelle Leroyer"
    },
    {
      "affiliations": [
        "Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), F-35000 Rennes, Rennes University Hospital, Rennes, Brittany, France"
      ],
      "name": "Jeff Morcet"
    },
    {
      "affiliations": [
        "Pharmacology, University Hospital Centre Rennes, Rennes, France",
        "CIC 1414, INSERM, Rennes, France"
      ],
      "name": "Claire Fougerou-Leurent"
    },
    {
      "affiliations": [
        "Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, F-35000 Rennes, Rennes University Hospital, Rennes, France"
      ],
      "name": "Alexandre Mansour"
    },
    {
      "affiliations": [
        "Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, Department of Anesthesia and Critical Care, Pontchaillou, Rennes University Hospital, Rennes, Brittany, France"
      ],
      "name": "Nicolas Nesseler"
    },
    {
      "affiliations": [
        "CHU de Rennes, Rennes, Brittany, France"
      ],
      "name": "VACARM investigators"
    },
    {
      "affiliations": [],
      "name": "ATLANREA study group"
    }
  ],
  "title": "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",
  "uid": "15522b8e-5522-55fb-bb8c-580d72c2cda4"
}