Mechanical Ventilation Complication
Conditions
Brief summary
The intraoperative driving pressure (∆P) has been recently identified as the greater independent predictor of postoperative pulmonary complications after one lung ventilation (OLV). The application of a positive end-expiratory pressure (PEEP) level of 5 or 10 cmH2O has been shown to reduce the ∆P and the V/Q mismatch (Spadaro 2017); however, the optimal PEEP level able to minimize the ∆P may change significantly across patients. The aim of this study is to describe the optimal PEEP levels in patients undergoing thoracic surgery
Interventions
PROCEDURERecruitment manoeuvers
Recruitment manoeuvers will be performed as follow Recruitment manoeuvers 1. set FIO2 at 1.0 2. Ppeak limit at 45 cmH2O 3. Respiratory rate set at 6 4. I:E set at 1:1 5. Raise the VT at step of 2 ml/kg PBW until the Pplat is between 30-40 cmH2O 6. If the maximum VT is set without rasing the Pplat, raise PEEP 7. Allow three respiratory cycles with Pplat between 30 and 40 cmH2O 8. End of RM The recruitment manouvers will be performed after 20 minutes of OLV. At the end of the RM, the VT will be set back to 5 ml/kg while the PEEP will be chosen according to the best static compliance with a decremental trial (from 16 cmH2O, lowering PEEP with steps of 2 cmH2O each until the best compliance is reached).
PROCEDUREincremental PEEP
In this group the a PEEP level will be added after 20 minutes from OLV. PEEP values will be chosen according to the best static compliance with an incremental trial (i.e. starting from ZEEP, the PEEP values will be increased in step of 2 cmH2O each until the best compliance is reached
Sponsors
Università degli Studi di Ferrara
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
• Patients undergoing VATS with OLV ≥2 hours
Exclusion criteria
* ASA (American Society of Anesthesiologists Physical Status Classification) score ≥ 4 * severe chronic respiratory failure (chronic obstructive pulmonary disease patients with GOLD stage 3 or 4 * preoperative hemoglobin less than 10 g ml-1 * hemodynamic instability (defined as a decrease in systolic arterial pressure of more than 20% from baseline),
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| pulmonary shunt, expressed as percentage, measured by ALPE system | 20 minutes after intervention |
Secondary
| Measure | Time frame |
|---|---|
| intraoperative driving pressure, measured as plateau pressure - PEEP | 20 minutes after intervention |
Other
| Measure | Time frame |
|---|---|
| intraoperative oxygenation, measured as PaO2/FIO2 ratio | 20 minutes after intervention |
Countries
Italy
Outcome results
None listed