One Lung Ventilation
Conditions
Keywords
One lung ventilation, Lung ultrasound, Alveolar recruitment
Brief summary
To observe the effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation(OLV).
Detailed description
One-lung ventilation(OLV) is essential in thoracic surgery for patient safety and better surgical view. However, pulmonary complications such as hypoxemia may be caused by OLV which might be preventable with adequate alveolar recruitment and positive end-expiratory pressure(PEEP). Alveolar recruitment has been performed with conventional methods without diagnostic tools in clinical setting. Ultrasound is a non-invasive, radiation-free device with high accuracy for the diagnosis of lung atelectasis. There are a few reports regarding the usefulness of lung ultrasound in other surgeries, but not in thoracic surgeries with OLV. Thus, investigators designed a study to observe the effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with OLV.
Interventions
PROCEDURELung-sono guided
The patient undergoing thoracic surgery is intubated with double lumen tube after induction of general anesthesia with propofol and remifentanil. In the intervention group, alveolar recruitment is performed to the non-surgical side of lung under examination with ultrasound just after anesthesia induction. During the gradual increment in the pressure of recruitment, the anesthesiologist can find the opening pressure that means the minimal pressure at which observed atelectasis starts to disappear. Then, alveolar recruitment is performed with the opening pressure until the atelectasis is not visible.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Elective thoracic surgery which requires one-lung ventilation with lateral decubitus position
Exclusion criteria
* Patients who refuse to agree * Previous lung surgical history * History of pneumothorax or bullae * Severe cardiopulmonary disease, COPD * Operation time \< 1hr
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of desaturation | intraoperative | SpO2\<95% |
| P/F ratio | 30 minutes after one-lung ventilation | PaO2/FiO2 ratio |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lung ultrasound score | just after anesthesia induction, end of surgery | Lung ultrasound score of atelectasis |
| Alveolar dead space | 30 minutes after one-lung ventilation | (PaCO2-PetCO2)xVt/PaCO2 |
| Pulmonary complications | intraoperative, during hospital stay(an average of 3 days) | respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, atelectasis, bronchospasm, aspiration pneumonitis |
Countries
South Korea
Outcome results
None listed