Aspiration Pneumonitis, Atelectasis, Bronchospasm, Pulmonary Infection, Respiratory Insufficiency
Conditions
Brief summary
Perioperative changes in regional ventilation by pulmonary electrical impedance tomography and spirometry will be investigated in patients at risk for postoperative pulmonary complications. Those patients undergo lung and flail chest surgery.
Detailed description
Postoperative pulmonary complications (Defined as pulmonary infection, pleural effusion, atelectasis, pneumothorax, bronchospasm, aspiration pneumonitis or respiratory insufficiency subsequent to surgery) increase the morbidity and mortality of surgical patients. Several independent factors determined by the patients' characteristics and the operative procedure increase the risk for those complications. The postoperative decrease of values measured by spirometry, such as the forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), were found in patients after major surgical procedures for several days. The postoperative reduction of those measurement can be the result of general functional limitations in those patients (e.g. by postoperative pain) or the result of a regional postoperative pulmonary complication (e.g. atelectasis, pleural effusion). The method of the electrical impedance tomography (EIT) enables to visualize the regional ventilation within a transversal section of the lung in real time. Studies examining the change of pulmonary EIT for several days postoperatively in spontaneously breathing patients are lacking. The aim of the present study is to examine perioperative changes in regional ventilation in spontaneously breathing patients during their recovery after lung and flail chest surgery. Moreover, the association of those changes with expected changes in spirometry is tested. Finally, in patients with evident postoperative pulmonary complications the value of pulmonary EIT to detect those changes is investigated. The study should improve the knowledge about the development of postoperative pulmonary complications and test the scientific and clinical value of pulmonary EIT in those spontaneously breathing patients.
Interventions
Pulmonary electrical impedance tomography, spirometry, pulse oximetry and query performed preoperatively, at the the third, fifth and seventh postoperative day
Sponsors
Wuerzburg University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult * Inpatient * Lung surgery under general anaesthesia
Exclusion criteria
* Missing informed consent * Outpatient * Emergency procedure * Revision surgery of hospitalized patients * Pneumothorax * Pleural effusion * Pleural effusion or pleural empyema with need to cannulate * scheduled Pneumonectomy * Expected hospital stay of less than three days * Pregnancy * Allergy against material of the electrode belt (silicone rubber, stainless steel, gold-plated brass) * Injured, inflamed or otherwise affected skin within the target region of the electrode belt * Unstable spine injury * Body mass index of more than 50 kg/m2 * Incapacity to lie quietly for the examination * Pacemaker, defibrillator or other active implant * Reoperation before the examination at the third postoperative day
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lateral Change from baseline in regional ventilation | baseline and 3. postoperative day | Regional ventilation is measured by pulmonary electrical impedance tomography. The ipsi- and contralateral change in the calculated 'Center of Ventilation' is evaluated |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lateral Change from baseline in regional ventilation depending on side of surgery | baseline and 3. postoperative day | Regional ventilation is measured by pulmonary electrical impedance tomography. The influence of the side of surgery on the ipsi- and contralateral change in the calculated 'Center of Ventilation' is evaluated |
Other
| Measure | Time frame | Description |
|---|---|---|
| Association between sagittal change of regional ventilation and change of forced vital capacity | baseline, 3., 5. and 7. postoperative day | Correlation testing is done sagittal change in the calculated 'Center of Ventilation' and the forced vital capacity in % of normal (FVC%) by spirometry |
| Association between lateral change of regional ventilation and change of forced vital capacity | baseline, 3., 5. and 7. postoperative day | Correlation testing is done on the ipsi- and contralateral change in the calculated 'Center of Ventilation' and the forced vital capacity in % of normal (FVC%) by spirometry |
| Impact on flail chest surgery to change from baseline in regional ventilation | baseline, 3., 5. and 7. postoperative day | Measured by EIT |
| Time shift in regional ventilation between ipsi- and contralateral lung | baseline, 3., 5. and 7. postoperative day | Regional ventilation is measured by pulmonary electrical impedance tomography. The shift in time of occurence of ipsi- and contralateral Ventilation is evaluated |
| Sagittal change from baseline in regional ventilation | baseline, 3., 5. and 7. postoperative day | Regional ventilation is measured by pulmonary electrical impedance tomography. The sagittal change in the calculated 'Center of Ventilation' is evaluated |
Countries
Germany
Outcome results
None listed