Healthy
Conditions
Brief summary
During general anesthesia lung collapses and atelectasis occurs. Preservation of atelectasis can cause pulmonary disfunction. The goal of safe anesthesia is to protect the lungs intraoperatively. Positive end-expiratory pressure (PEEP) is distending pressure that prevents alveolar collapse during mechanical ventilation and is a part of recruitment maneuver that is often used in patients on mechanical ventilation. Overall effect of PEEP is improvement in lung function. PEEP can have adverse effects on hemodynamics. The objective of this study was to assess the effect of step up and down PEEP titration on lung function and hemodynamics in healthy preschool children during general anesthesia. One group of children was ventilated with constant PEEP. the other was submitted to PEEP titration. Changes in lung compliance, gas exchange and hemodynamic status were documented as well as any unwanted effects.
Detailed description
Seventy preschool children American Society of Anesthesiologists classification system (ASA) I and II scheduled for non-cardiothoracic surgery were allocated in two groups. Interventional group (n=35) received PEEP titration and Control group (n=35) didn't. They were ventilated only with PEEP 3. PEEP titration: In Intervention group, 20 minutes before the end of anesthesia PEEP was increased by 2 on every 5 breaths to 11. Ventilation with PEEP 11 was maintained for 2 minutes. Then PEEP was reduced by 2 on every 5 breaths to 5 and remain as until awakening. Total time to perform titration was 5 minutes. Blood was collected in both groups, in equal points of time that is: after induction, 20 minutes before the end of surgery and after the end of surgery (20th minute). Investigators tested differences of outcome variables between groups and within the Interventional group before and after PEEP titration. Hemodynamic monitoring and monitoring of lung function were conducted in Interventional group to observe changes during PEEP titration.
Interventions
PROCEDUREincrease and decrease positive end-expiratory pressure
20 minutes before the end of anesthesia and surgery PEEP was increased by 2 on every 5 breaths to 11. Ventilation with PEEP 11 was maintained for 2 minutes. Then, PEEP was reduced by 2 on every 5 breaths to 5 cmH2O
Sponsors
Mother and Child Health Institute of Serbia Dr Vukan Cupic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
randomized parallel controlled clinical trial
Eligibility
Sex/Gender
ALL
Age
3 Years to 7 Years
Healthy volunteers
Yes
Inclusion criteria
* age 3-7; ASA I and II * absence of cardiovascular and respiratory comorbidity
Exclusion criteria
* current or recent (up to 4 weeks) upper airway infection * present of gastroesophageal reflux * allergic reactions to anesthetics * contraindication to chosen anesthetics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Partial pressure of oxygen | 10 minutes after PEEP titration | measured partial pressure of oxygen in arterial blood at the end of surgery in Interventional and Control group. |
| Partial pressure of carbon dioxide | 10 minutes after PEEP titration | measured partial pressure carbon dioxide in arterial blood at the end of surgery in Interventional and in Control group |
| Lung compliance | 10 minutes after PEEP titration | spirometric measurement of dynamic lung compliance at the end of surgery in Interventional and Control group |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative hemoglobin oxygen saturation | 4 hours after extubation | hemoglobin oxygen saturation measured with puls oximeter |
| intraoperative hemodynamic status | 5 minutes | invasive blood pressure monitoring during PEEP titration in Interventional group |
| intraoperative respiratory adverse effect | 5 minutes | airway pressure monitoring during PEEP titration in Interventional group |
Countries
Serbia
Outcome results
None listed